Background Pain control is the most important theme for treatment of rheumatoid arthritis (RA) patient. For pain control, it is obviously important key to control disease activity control. However, patient status at start of treatment (BL), can be also important as well as disease activity control. Including these factors, keys that can reduce pain should be clarified.
Objectives In this study, factors that affect on pain control were evaluated statistically from real clinical data.
Methods In 685 RA patients who have been treated for more than 1 year, 500 patients were monitored their disease activity with parameters in 28-joints disease activity index with C-reactive protein (DAS28-CRP), pain score with using visual analogue scale (PS-VAS), modified Health Assessment Questionnaire Disability Index (mHAQ). Drugs administered for patient had been checked at the time of consult.
PS-VAS at consult was evaluated, as it demonstrated no more than 15mm, or decrease than last time more than 20mm was evaluated as “Pain Reduced”. Patients sex, ACP, Sharp/van der Heijde Score (SHS), patients current age, history length, DAS28-CRP and its components, PS-VAS at BL, and followed consultation, drug usage and its dosage were evaluated for Pain Reduced statistically with Binary Logistic Regression Analysis. Significant level was set within 1%.
Results 14,005 times from 495 patients were enrolled in this study. At BL, male patient, higher ACPA, younger age at onset and at BL, older age at following consultation, short following term, smaller SvdHS, greater tenderness joint count (TJC), swollen joint count (SJC), smaller patient's global assessment (PGA), evaluator's global assessment (EGA), great CRP, and smaller mHAQ and DAS28-CRP at BL demonstrated significant contribution on Pain Reduce. In following consult, smaller mHAQ, PS-VAS, and DAS28-CRP, in which smaller PGA and EGA, demonstrated significant contribution on Pain Reduce. In drugs, paraetamol/tramadol combination drug use, non-steroid anti-inflammation drug (NSAIDs) use, pregabalin use, tofacitinib use, and opioid use, and methotrexate dose decrease demonstrated significant contribution on Pain Reduce.
Conclusions These results suggest that pain control for RA patient depends on patient's status at baseline. And followed disease activity control and activity in daily life (ADL) maintenance. In adding with these, drug selection is also important key. It is also suggested specific drugs have higher effect on pain control. Anti-chronic pain agent can be candidate for pain relief for the patient who complains remnant pain even after successful disease activity control and ADL maintenance.
Disclosure of Interest None declared