Chronic widespread pain in patients with rheumatoid arthritis and the relation between pain and disease activity measures over the first 5 years.
OBJECTIVE
To study the prevalence of chronic widespread pain (ChWP), chronic regional pain (ChRP), and fibromyalgia in patients with early rheumatoid arthritis (RA) followed for 5 years after inclusion, and to study the effect of pain on measures of disease activity and function.


METHODS
A questionnaire was sent to 1910 patients participating in the Better Anti-Rheumatic Pharmacotherapy study. The responders (73%) were divided into 3 groups according to the reported pain duration and distribution - patients having no chronic pain (NChP), ChWP, and ChRP. Outcome measures were the 28-joint Disease Activity Score (DAS28), the Health Assessment Questionnaire (HAQ), and C-reactive protein (CRP).


RESULTS
Thirty-four percent of respondents reported ChWP, 46% ChRP, and 20% NChP. Patients reporting ChWP were more often women and had more pain and tender joints at inclusion. From 6 months to 5 years of followup, mean DAS28, visual analog scale (VAS) pain, VAS global health, and HAQ were significantly higher in the ChWP group than in the other groups. However, all groups showed a similar pattern in swollen joint count, erythrocyte sedimentation rate (ESR), and CRP. From 12 months the ChWP group was treated with prednisolone to a greater extent than the ChRP group, and it had a rate of treatment with disease-modifying antirheumatic drugs similar to that of the ChRP group.


CONCLUSION
ChWP is a common feature in RA, more associated with high values for variables related to pain such as the DAS28 and HAQ than to indicators of ongoing inflammation such as swollen joint count, ESR, and CRP. Patients with ChWP should be identified so that adequate treatment also of the noninflammatory pain may be instituted.
['Andersson|Maria L E|ML|', 'Svensson|Björn|B|', 'Bergman|Stefan|S|']
D000328:Adult D000368:Aged D018501:Antirheumatic Agents D001172:Arthritis, Rheumatoid D059350:Chronic Pain D005260:Female D005356:Fibromyalgia D005500:Follow-Up Studies D006801:Humans D008137:Longitudinal Studies D008297:Male D008875:Middle Aged D015995:Prevalence D012074:Remission Induction D012720:Severity of Illness Index D011795:Surveys and Questionnaires
CHRONIC WIDESPREAD PAIN PAIN RHEUMATOID ARTHRITIS DISEASE ACTIVITY MEASURES CLINICAL ASSESSMENT