Pain sensitisation and joint inflammation in patients with active rheumatoid arthritis
Introduction Despite better therapies and strategies, many people with rheumatoid arthritis (RA) have persistent pain, often from abnormal pain processing, now termed nociplastic pain. However, RA patients with fibromyalgia (FM), a central nociplastic pain syndrome, also have power doppler ultrasoun...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-02-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/10/1/e003784.full |
| _version_ | 1797222192717496320 |
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| author | Sam Norton Bruce W Kirkham James Galloway Khaldoun Chaabo Toby Garrood Zoe Rutter-Locher Estee Chan Alex Vincent |
| author_facet | Sam Norton Bruce W Kirkham James Galloway Khaldoun Chaabo Toby Garrood Zoe Rutter-Locher Estee Chan Alex Vincent |
| author_sort | Sam Norton |
| collection | DOAJ |
| description | Introduction Despite better therapies and strategies, many people with rheumatoid arthritis (RA) have persistent pain, often from abnormal pain processing, now termed nociplastic pain. However, RA patients with fibromyalgia (FM), a central nociplastic pain syndrome, also have power doppler ultrasound (PDUS+) joint inflammation. To understand the complex causes of pain, we performed clinical examination and patient-reported outcome measures (PROMs) plus comprehensive PDUS evaluation not previously combined.Methods In a cross-sectional study of sequential RA patients with at least moderate DAS28 erythrocyte sedimentation rate disease activity, we assessed 66/68 joints for swelling and tenderness, respectively, FM American College of Rheumatology 2010 diagnostic criteria, completed PROMs for function, quality of life and mood, alongside PDUS examination of 44 joints. Statistical analysis included logistic regression modelling and regularised (lasso) logistic regression methods.Results From 158 patients, 72 (46%) patients met FM criteria, with significantly worse tender joint counts and PROMs, but no differences in PDUS compared with the non-FM group. Categorising patients by PDUS+ joint presence and/or FM criteria, we identified four distinct groups: 43 (27.2%) patients with −FM−PD, 43 (27.2%) with −FM+PD, 42 (26.6%) with +FM−PD and 30 (19%) with +FM+PD. Both FM+ groups had worse PROMs for fatigue, mood and pain, compared with the FM− groups. We were unable to develop algorithms to identify different groups.Conclusion The unexpected group −FM−PD group may have peripheral nociplastic pain, not commonly recognised in rheumatology. Only 46% of patients demonstrated PDUS+ inflammation. However clinical examination and PROMs did not reliably differentiate groups, emphasising PDUS remains an important tool. |
| first_indexed | 2024-04-24T13:17:26Z |
| format | Article |
| id | doaj.art-9f332f35f41242d5b9cf229f9367f721 |
| institution | Directory Open Access Journal |
| issn | 2056-5933 |
| language | English |
| last_indexed | 2024-04-24T13:17:26Z |
| publishDate | 2024-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj.art-9f332f35f41242d5b9cf229f9367f7212024-04-04T17:20:07ZengBMJ Publishing GroupRMD Open2056-59332024-02-0110110.1136/rmdopen-2023-003784Pain sensitisation and joint inflammation in patients with active rheumatoid arthritisSam Norton0Bruce W Kirkham1James Galloway2Khaldoun Chaabo3Toby Garrood4Zoe Rutter-Locher5Estee Chan6Alex Vincent7Academic Department of Rheumatology, King`s College London, London, UKRheumatology, Guy`s and St Thomas` Hospitals NHS Trust, London, UKAcademic Department of Rheumatology, King`s College London, London, UKRheumatology, Guy`s and St Thomas` Hospitals NHS Trust, London, UKRheumatology, Guy`s and St Thomas` Hospitals NHS Trust, London, UKRheumatology, Guy`s and St Thomas` Hospitals NHS Trust, London, UKRheumatology, Guy`s and St Thomas` Hospitals NHS Trust, London, UKGuy`s and St Thomas` Hospitals NHS Trust, London, UKIntroduction Despite better therapies and strategies, many people with rheumatoid arthritis (RA) have persistent pain, often from abnormal pain processing, now termed nociplastic pain. However, RA patients with fibromyalgia (FM), a central nociplastic pain syndrome, also have power doppler ultrasound (PDUS+) joint inflammation. To understand the complex causes of pain, we performed clinical examination and patient-reported outcome measures (PROMs) plus comprehensive PDUS evaluation not previously combined.Methods In a cross-sectional study of sequential RA patients with at least moderate DAS28 erythrocyte sedimentation rate disease activity, we assessed 66/68 joints for swelling and tenderness, respectively, FM American College of Rheumatology 2010 diagnostic criteria, completed PROMs for function, quality of life and mood, alongside PDUS examination of 44 joints. Statistical analysis included logistic regression modelling and regularised (lasso) logistic regression methods.Results From 158 patients, 72 (46%) patients met FM criteria, with significantly worse tender joint counts and PROMs, but no differences in PDUS compared with the non-FM group. Categorising patients by PDUS+ joint presence and/or FM criteria, we identified four distinct groups: 43 (27.2%) patients with −FM−PD, 43 (27.2%) with −FM+PD, 42 (26.6%) with +FM−PD and 30 (19%) with +FM+PD. Both FM+ groups had worse PROMs for fatigue, mood and pain, compared with the FM− groups. We were unable to develop algorithms to identify different groups.Conclusion The unexpected group −FM−PD group may have peripheral nociplastic pain, not commonly recognised in rheumatology. Only 46% of patients demonstrated PDUS+ inflammation. However clinical examination and PROMs did not reliably differentiate groups, emphasising PDUS remains an important tool.https://rmdopen.bmj.com/content/10/1/e003784.full |
| spellingShingle | Sam Norton Bruce W Kirkham James Galloway Khaldoun Chaabo Toby Garrood Zoe Rutter-Locher Estee Chan Alex Vincent Pain sensitisation and joint inflammation in patients with active rheumatoid arthritis RMD Open |
| title | Pain sensitisation and joint inflammation in patients with active rheumatoid arthritis |
| title_full | Pain sensitisation and joint inflammation in patients with active rheumatoid arthritis |
| title_fullStr | Pain sensitisation and joint inflammation in patients with active rheumatoid arthritis |
| title_full_unstemmed | Pain sensitisation and joint inflammation in patients with active rheumatoid arthritis |
| title_short | Pain sensitisation and joint inflammation in patients with active rheumatoid arthritis |
| title_sort | pain sensitisation and joint inflammation in patients with active rheumatoid arthritis |
| url | https://rmdopen.bmj.com/content/10/1/e003784.full |
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