Background Chronic pain is a key component of rheumatoid arthritis (RA). Although pain is reduced with the control of inflammation at the first years of the disease, pain increases over time with different pathways just as central sensitization. Fatigue, sleep problems and depressive symptoms with chronic pain are common problems in patients with RA (1,2).
Objectives We aimed to investigate the frequency of widespread pain, sleep disorders, fatigue, and depressive symptoms in RA patients. Furthermore discrepancy of these symptoms and disorders were analyzed between female and male RA patients.
Methods One hundred and sixty one RA patients (female: 119, male: 42) and 68 healthy controls (female: 52, male: 16) were enrolled in the study. Widespread pain index (WPI) with nineteen body parts that was identified by 2010 fibromyalgia diagnostic criteria was interrogated. Pain visual analog scale (VAS), Health Assessment Questionnaire (HAQ), Physician global assessment (PhGA), Fatigue severity scale (FSS), Pittsburgh sleep quality index (PSQI), Beck depression inventory (BDI) were evaluated in both RA patients and healthy controls. Morning stiffness (MS), Rheumatoid arthritis quality of life (RAQOL) and disease activity score 28 (DAS28) were assessed in RA patients. Data were analyzed in female and male RA patients.
Results The mean PhGA, HAQ, BDI, FSS, WPI values of RA patients were worse than healthy controls (p=0.012, 0.000, 0.008, 0.033, 0.044 respectively). There was no difference between RA and healthy controls in terms of sleep disorders. The mean age, disease duration, MS, swollen joint count, C-reactive protein, PhGA and BDI were similar in female and male RA patients. WPI, VAS pain, tender joint count, HAQ, RAQOL, FSS, PSQI, and DAS 28 were higher in females (Table 1).
Conclusions RA is a disease that increases fatigue, depressive symptoms and widespread pain.DAS 28 scores were higher due to the increased pain scores and tender joint count that are subjective parameters in female RA patients. Pain scores in females are significantly higher than in males, and pain exacerbated by central sensitization pathway in women may lead to sleep disorders and fatigue, but not increase depressive symptoms.
The role of central nervous system in the generation and main tance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgia. Lee YC, Nassikas NJ, Clauw DJ. Arthritis Research and Therapy (2011) 13:211–221.
Fatigue in patients with rheumatic diseases. Dupond JL. Joint Bone Spine (2011). 78:156–160.
Disclosure of Interest None declared
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