Background One might consider pain accompanying musculoskeletal conditions as a separate illness entity deserving specific treatment. A subgroup of early Rheumatoid Arthritis (RA) patients has remaining pain despite adequate disease control and this might be reflected in the use of analgesics and NSAIDs.
Objectives To investigate the usage of analgesics and antiphlogistics prospectively in the pragmatic randomized controlled CareRA trial and describe the users of such drugs taking into account body mass index (BMI), VAS pain and DAS28CRP.
Methods This study utilized data from the CareRA trial, a 2-year prospective investigator-initiated multicentre pragmatic RCT in patients with early RA (≤1 year) comparing different early intensive treat to target strategies, including glucocorticoid (GC) bridging, aiming for remission in all participants.
All concomitant medication for each patient was recorded, including: name, dose, frequency/timing, continuous/intermittent use, start/end date and indication (possibly/definitely RA-related or other). Meaningful sub-classifications were made (analgesics, cox2-selective and non-selective NSAIDs). We defined two subgroups with prolonged analgesic/NSAID use till w104: the pre-induction group starting before/at baseline (BL) and the post-induction group starting w28-w52, after GC step-down.
Results From the CareRA cohort (n=379), 90% were on analgesics/NSAIDs at some time during the study and 84% had already started before inclusion (mean 24 weeks). In general, we observed a decreasing trend in the use of analgesics/NSAIDs, with a slight increase after GC step-down. Overall, 266 patients used non-selective and 131 cox2-selective NSAIDs, 154 paracetamol and 85 opioids.
Of the total population, 15, 5% (53 patients) started long-term analgesics/NSAIDs before/at BL (pre-induction group) and 13% (45 patients) from w28-w52 (post-induction group).
A detailed distribution of on-demand/daily analgesic/NSAID use is provided in the table below.
Proportionally more patients were using NSAIDs in the post-induction group and paracetamol in the pre-induction group.
Mean DAS28CRP (BL-w104) in the pre-induction group was 3.11 (±0.70) and mean VAS pain 32.7 (±16.3). In this group 62.3% had sustained low disease activity while taking continuous analgesics/NSAIDs. Results in the post-induction group were comparable.
Analgesic/NSAID use was not significantly associated with mean (BL-w104) BMI, DAS28CRP or VAS pain.
Conclusions Analgesics/NSAID intake in early RA was high (90%) and remarkably about 30% continued using these drugs, despite overall low disease activity. This high consumption might be explained by the ambiguous nature of arthritis-related pain and the lack of differentiation between nociceptive and non-nociceptive pain. Therefore pain management in early RA deserves more attention.
Verschueren, P. et al. ffectiveness of MTX with step-down glucocorticoid remission induction (COBRA Slim) vs other intensive treatment strategies for early RA in a treat-to-target approach: 1-year results of CareRA, a randomised pragmatic open-label superiority trial. Ann Rheum Dis.
Disclosure of Interest None declared