Background The primary treatment goal in rheumatoid arthritis (RA) patients is to reach remission. Earlier diagnosis, advancements in disease-modifying antirheumatic drugs, and improved treatment strategies have enabled increasing numbers of RA patients to achieve remission. However, the definition of remission involves the fulfillment of specific criteria, which include a number of swollen and tender joints, the erythrocyte sedimentation rate (ESR), and the visual analog scale of pain (VAS pain). Some patients with RA in remission wished to take painkillers because they experienced pain and physical limitations in their daily life or at work. Is reaching remission a realistic goal?
Objectives To evaluate VAS pain and patient's global assessment (PGA) in those with RA in remission, and to determine the types and frequency of which painkillers were received.
Methods In a study of 554 RA patients with a definite RA diagnosis according to 1987 ACR criteria, we enrolled 235 patients (82% females). All patients had DAS28-ESR <2.6, defined as clinical remission, and had no acute pain as a result of operation or trauma. The mean age and disease activity were 53.6 years and 2.67, respectively. Seventy-one percent of patients were treated with MTX, 30.2% with glucocorticoids, and 38.4% with a biological agent. We evaluated VAS pain and PGA and investigated why patients experienced dissatisfaction with VAS pain and PGA. Moreover, we elucidated how many patients used painkillers and what types of painkillers were used.
Results The mean values of clinical and laboratory data were described as follows: 28 swollen joints, 0.69; 28 tender joints, 1.56; RF, 157 IU/mL; C-reactive protein, 0.14 mg/dL; ESR, 19 mm/h; and health assessment questionnaire disability index score, 0.618. Steinblocker stages (I/II/III/IV) were (166/51/18/0), respectively and Steinblocker classes (I/II/III/IV) were (155/68/12/0), respectively. The mean VAS pain was 1.81. Thirty-five (14.9%) of 235 patients had VAS pain >3 (Fig. 1). The mean PGA was 1.54. Seventeen patients (7.2%) reported PGA >3 (Fig. 2). Reasons for VAS pain or PGA of >3 were musculoskeletal pain (48.6%), neuropathic pain (23.1%), psychological reasons (9.3%), and other (19%). Thirty-one patients (13.2%) were treated with painkillers such as NSAIDs (46.2%), acetaminophen (22.5%), pregabalin (18.6%), tramadol (4.1%), and other (8.6%). The mean values for VAS pain and PGA were improved after using painkillers by 0.73 and 0.36, respectively. There was a significant difference in the improvement rate of VAS pain and PGA between pre-use and post-use of pain-killer (Fig. 3).
Conclusions VAS pain and PGA are important for understanding the patients' functional disabilities and problems. We should attend to patients' demands and make an informed decision to form a realistic goal for RA treatment. Given that VAS pain and PGA were improved because of the use of painkillers in the current study, we suggest that the ability to appropriately prescribe painkillers is an important method with which to satisfy RA patients in remission.
Disclosure of Interest None declared
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