Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: a longitudinal observational study.
Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: a longitudinal observational study.
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DOI：
10.1186/ar3353
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发表时间：
2011-06-08
影响因子：
4.9
通讯作者：
Solomon DH
中科院分区：
文献类型：
--
作者：
Lee YC;Cui J;Lu B;Frits ML;Iannaccone CK;Shadick NA;Weinblatt ME;Solomon DH
对于大多数类风湿性关节炎(RA)患者来说，疾病缓解已成为一个可行的目标；然而，患者报告的症状，如疼痛，可能会在缓解后持续存在。我们根据疾病活动评分(DAS28-CRP4)和美国风湿病学会/欧洲风湿病联盟(ACR/EULAR)缓解标准来评估缓解期RA患者的疼痛发生率。对Brigham类风湿性关节炎序贯研究中RA患者的数据进行了分析，数据为基线数据和1年数据。DAS28缓解定义为DAS28-CRP4；2.6。疼痛缓解标准包括(A)一个或多个肿胀的关节，(B)一个或多个压痛的关节，(C)C-反应蛋白≤1 mg/dl，(D)患者总体评估评分≤1。疼痛严重程度由多维健康评估问卷中的疼痛评分来衡量。使用多变量线性回归分析基线临床预测因素与基线和1年MDHAQ疼痛之间的关系。在基线和1年的865名患者中，157名(18.2%)在两个时间点都符合DAS28-CRP4缓解标准。37例(4.3%)在基线和1年时达到ACR/EULAR缓解标准。基线时临床显著疼痛(MDHAQ Pain≥4)的发生率在符合DAS28-CRP4缓解标准的患者中为11.9%，在符合ACR/EULAR缓解标准的患者中为零。在横断面和纵向分析中，患者总体评估、MDHAQ功能、MDHAQ疲劳、MDHAQ睡眠和关节炎自我效能与MDHAQ疼痛显著相关(P≤0.0005)。纵向分析显示低肿胀关节数与高MDHAQ疼痛相关(P=0.02)，但横断面分析没有相关性。炎症性疾病活动性和关节损害的其他指标在基线或1年时与MDHAQ疼痛没有显著相关性。在相当大比例的DAS28缓解期患者中，临床上明显的疼痛持续存在，但在ACR/EULAR缓解期患者中则不存在。在DAS28缓解期的患者中，患者总体评估、残疾、疲劳、睡眠问题和自我效能与基线和1年的疼痛严重程度密切相关，而炎症性疾病活动和关节损伤与基线或1年的疼痛严重程度升高没有显著相关性。
Disease remission has become a feasible goal for most rheumatoid arthritis (RA) patients; however, patient-reported symptoms, such as pain, may persist despite remission. We assessed the prevalence of pain in RA patients in remission according to the Disease Activity Score (DAS28-CRP4) and the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria. Data were analyzed from RA patients in the Brigham Rheumatoid Arthritis Sequential Study with data at baseline and 1 year. DAS28 remission was defined as DAS28-CRP4 <2.6. The ACR/EULAR remission criteria included (a) one or more swollen joints, (b) one or more tender joints, (c) C-reactive protein ≤1 mg/dl, and (d) patient global assessment score ≤1. Pain severity was measured by using the pain score from the Multi-Dimensional Health Assessment Questionnaire (MDHAQ). The associations between baseline clinical predictors and MDHAQ pain at baseline and 1 year were assessed by using multivariable linear regression. Among the 865 patients with data at baseline and 1 year, 157 (18.2%) met DAS28-CRP4 remission criteria at both time points. Thirty-seven (4.3%) met the ACR/EULAR remission criteria at baseline and 1 year. The prevalence of clinically significant pain (MDHAQ pain ≥4) at baseline ranged from 11.9% among patients meeting DAS28-CRP4 remission criteria to none among patients meeting ACR/EULAR remission criteria. Patient global assessment, MDHAQ function, MDHAQ fatigue, MDHAQ sleep, and arthritis self-efficacy were significantly associated with MDHAQ pain in cross-sectional (P ≤ 0.0005) and longitudinal analyses (P ≤ 0.03). Low swollen-joint counts were associated with high MDHAQ pain in longitudinal analyses (P = 0.02) but not cross-sectional analyses. Other measures of inflammatory disease activity and joint damage were not significantly associated with MDHAQ pain at baseline or at 1 year. Clinically significant pain continues among a substantial proportion of patients in DAS28 remission but not among those in ACR/EULAR remission. Among patients in DAS28 remission, patient global assessment, disability, fatigue, sleep problems, and self-efficacy are strongly associated with pain severity at baseline and 1 year, whereas inflammatory disease activity and joint damage are not significantly associated with elevated pain severity at either baseline or 1 year.
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影响因子：
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作者：
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