Pain in rheumatoid arthritis: a seven-year follow-up study of pain distribution and factors associated with transition from and to chronic widespread pain

Abstract

Objective

To study transitions from and to chronic widespread pain (CWP) over 7 years in patients with rheumatoid arthritis (RA).

Method

Two postal questionnaires were sent to patients included in the BARFOT (Better Anti-Rheumatic Pharmacotherapy) study, the first in 2010 and the second in 2017. The questionnaires assessed pain, number of tender and swollen joints, functional disability, health-related quality of life (HRQoL), pharmacological treatment, lifestyle factors, and patient-reported body mass index (BMI). The responders to both questionnaires were divided into three groups according to the reported pain duration and distribution: patients having no chronic pain (NCP), chronic regional pain (CRP), and CWP.

Results

In all, 953 patients answered the questionnaires at both time-points. One-third (324) of the patients reported CWP in 2010, and 140 (43%) of the patients had transition to NCP or CRP in 2017. In multivariate logistic regression models, adjusting for age, gender, and disease duration, transition from CWP was associated with normal BMI, fewer tender joints, less pain, less fatigue, fewer pain regions, less disability, better HRQoL, and biologic treatment. In 2010, 628 patients reported NCP or CRP, whereas 114 of them reported CWP in 2017. Transition to CWP was associated with female gender, obesity, more tender and swollen joints, higher pain-related variables, worse disability, and worse HRQoL.

Conclusion

There are modifiable factors associated with transitions from and to CWP that could be identified. Paying attention to these factors could improve pain treatment in the management of RA.

Acknowledgements

The authors thank the BARFOT study group.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supporting information

Additional Supporting Information may be found in the online version of this article.

Supplementary Figure 1. Flowchart of the BARFOT study.

Supplementary Figure 2. Flowchart of the postal surveys.

Supplementary Figure 3. Pain mannequin used in the questionnaires.

Supplementary Table 1. Patient-reported data from questionnaire in 2017, individuals who transitioned to no CWP compared to those who still reported CWP.

Supplementary Table 2. Patient-reported data from questionnaire in 2017, individuals who transitioned to CWP compared to those who still reported no CWP.

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Additional information

Funding

This work was supported by the Foundation for Assistance to Disabled People in Skåne; Reumatikerförbundet.