Background Pain is the symptom people with rheumatoid arthritis (RA) have prioritized highest for improvement . Treating to target and aiming for remission in early RA may reduce pain, but there is limited knowledge about the impact of modern treatment strategies on pain in RA patients classified using the 2010 ACR/EULAR criteria.
Objectives The objective of this study was to explore and describe changes in the levels of pain in early RA during the first two years after starting DMARD treatment.
Methods Patients with symptom duration of less than 2 years from first swollen joint who fulfilled the 2010 ACR/EULAR classification criteria for RA, and were DMARD naïve with indication for DMARD treatment were recruited from 11 rheumatology centres and followed for 2 years in the ARCTIC trial. The treatment target was remission, and DMARDs were prescribed using an algorithm developed according to international recommendations. Swollen joints and joints with ultrasound power Doppler synovitis were injected with intra-articular corticosteroids. Pain was recorded on a Visual Analogue Scale (VAS 0–100 mm) at every visit, and categorised according to Jensen et al. with cut points for no pain set at 0–4 mm, mild 5–44 mm, moderate 45–74 mm and severe pain 75–100 mm . Short Form-36 (SF-36) bodily pain was recorded, and transformed to a scale from 0–100, with high scores indicating low bodily pain.
Results A total of 205 early RA patients were included: 61.5% female, 82.4% ACPA positive, and mean (SD) age 52.2 (13.4) years. At initiation of DMARD treatment the mean (SD) 44-swollen joint count was 10.2 (7.2), Ritchie Articular Index 8.14 (6.5), ESR 24 (19) mm/hr and Patient Global Assessment 49 (24) mm. The mean (SD) DAS value was 3.4 (1.1); 20.1% were in low disease activity, 47.1% in moderate disease activity and 32.8% in high disease activity according to DAS. VAS pain at baseline was median (IQR) 45 (27–68) mm, and decreased to 12 (4–27) mm after 1 month, after 1 year to 6 (2–20) mm and after 2 years VAS pain was 7 (2–23) mm; see figure for details. Mean (SD) SF-36 bodily pain at baseline was 40 (21), and increased after 12 months to 73 (23) and 24 months to 74 (24). At baseline less than 3% of the patients reported no pain, after 3/6/12/24 months this proportion increased to 27/32/41/41%, respectively. In the interval 12 to 24 months more than 87% of patients reported exclusively either no or mild pain.
Conclusions In this cohort of early DMARD-naïve RA patients treated according to modern treatment strategies aiming for remission, there was a substantial and significant reduction of pain after 1 month. Pain levels decreased further during the first year, and this reduction was sustained during the first 2 years of follow-up. Early intervention and treating to target in this population fulfils the patients' prioritised goal of minimising pain, leading to a decreased burden of pain in RA.
Heiberg, T. et al. Arthritis Care Res 2002.
Jensen, M.P. et al. The Journal of Pain, 2003.
Disclosure of Interest E. Moholt: None declared, A.-B. Aga: None declared, I. Olsen: None declared, H. Hammer: None declared, T. Uhlig: None declared, A. Kongtorp: None declared, H. Lunøe: None declared, E. Styrmoe: None declared, S. Lillegraven: None declared, T. Kvien: None declared, E. Haavardsholm Grant/research support from: AbbVie, Pfizer Inc, MSD, Roche Pharmaceuticals, UCB