Background Pain is a central symptom of the rheumatic diseases and chronic widespread pain (CWP) has been reported to be more common in Rheumatoid arthritis (RA) than in the general population (34% vs. 11-14%) and affect both disease activity and function (1,2,3). Information on CWP in Spondyloarthritis (SpA) is limited as is information on how it can influence aspects of disease outcome.
Objectives To study the prevalence of chronic pain, in Ankylosing Spondylitis (AS) and undifferentiated Spondyloarthritis (USpA) and its impact on health-related quality of life, disease activity, physical function, anxiety, depression and self-efficacy.
Methods 2162 patients with SpA identified in a regional health-care register (SpA Scania cohort) answered a cross-sectional postal survey including questions on pain. 597 patients with AS and 389 with USpA were included. The patients were divided in groups according to self-reported pain duration and distribution: chronic widespread pain (CWP), chronic regional pain (CRP) and non-chronic pain (NCP). The outcome measures used were EuroQol-5 domain (EQ-5D), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Hospital Anxiety and Depression scale (HAD), and The Arthritis Self-Efficacy Scale (ASES).
Results 563 patients with AS and 370 with USpA answered questions on pain distribution and duration. 46% of the patients with AS reported CWP vs. 51% with USpA, 18% in AS vs. 21% in USpA reported CRP and 36% in AS vs. 28% in USpA reported NCP. More women than men, in both AS (53%/41%) and USpA (57%/40%) reported CWP. In CRP the gender distribution was almost equal for both AS (17%/19%) and USpA (21%/21%) and less women than men reported NCP (AS 30%/40% vs. USpA 21%/39%). When comparing AS and USpA in CWP, CRP and NCP, only minor differences were seen in the outcome measures. However, patients with CWP vs. NCP reported worse (p<0.001) in all outcome measures (EQ-5D 0.56 vs. 0.79, BASDAI 5.2 vs. 2.5, BASFI 4.4 vs. 1.7, ASES pain 47.3 vs. 63.0, HAD anxiety 6.8 vs 4.8, HAD depression 5.1 vs 3.2) without any major differences between women and men.
Conclusions In this study CWP was found to be more common in the SpA subgroups, AS and USpA, than in both RA and in the general population. The incidence of CWP strongly explains impaired health-related quality of life, disease activity, function, anxiety, depression, and self-efficacy regardless of SpA subgroup and with only small differences for gender.
Andersson MLE, Svensson B, Bergmen S. Chronic widespread pain in patients with Rheumatoid arthritis and the relation between pain and disease activity measures over the first 5 years. J Rheumatol 2013;40:1977-85;doi:10.3899/jrheum.130493
Bergman S, Herrstrom P, Hogstrom K, Petersson IF, Svensson B, Jacobsson LT. Chronic musculoskeletal pain, prevalence rates, and sociodemographic associations in a Swedish population study. J Rheumatol 2001;28:1369-77
Breivik H, Colett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006;10:287-333
Disclosure of Interest None declared
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