Predictors of unacceptable pain with and without low inflammation over 5years in early rheumatoid arthritis-an inception cohort study

ObjectivesPain is a major symptom in patients with rheumatoid arthritis (RA). In early RA, pain is usually due to synovitis, but can also persist despite effective anti-inflammatory treatment. The objective of this study was to investigate the pain course over time and predictors of unacceptable pain and unacceptable pain with low inflammation, in patients with early RA.MethodsAn inception cohort of 232 patients with early RA, recruited in 1995-2005, was followed in a structured programme for 5years. Pain was assessed using a visual analogue scale (VAS; 0-100). Unacceptable pain was defined as VAS pain >40 based on the patient acceptable symptom state (PASS) and low inflammation as CRP <10mg/l. Baseline predictors of unacceptable pain were evaluated using logistic regression analysis.ResultsPain improved significantly during the first 6months, but then remained basically unchanged. Thirty-four per cent of the patients had unacceptable pain 5years after inclusion. Baseline predictors of unacceptable pain after 5years were lower swollen joint counts [odds ratio (OR) 0.71 per standard deviation (95% confidence interval (CI) 0.51-0.99)] and higher VAS for pain and global assessment of disease activity. Unacceptable pain with low inflammation after 5years was negatively associated with anti-CCP antibodies [OR 0.50 (95% CI 0.22-0.98)].ConclusionOver one third of the patients had unacceptable pain 5years after inclusion. Lower swollen joint count was associated with unacceptable pain at 5years. The results may be explained by the positive effects of treatment on pain related to inflammation. Non-inflammatory long-lasting pain appears to be a greater problem in anti-CCP-negative patients.