Chronic Widespread Pain in Patients with Rheumatoid Arthritis and the Relation Between Pain and Disease Activity Measures over the First 5 Years
Chronic Widespread Pain in Patients with Rheumatoid Arthritis and the Relation Between Pain and Disease Activity Measures over the First 5 Years
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DOI：
10.3899/jrheum.130493
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发表时间：
2013-12-01
影响因子：
3.9
通讯作者：
Bergman, Stefan
中科院分区：
文献类型：
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作者：
Andersson, Maria L. E.;Svensson, Bjorn;Bergman, Stefan
目标。研究纳入后随访5年的早期类风湿关节炎（RA）患者慢性广泛性疼痛（ChWP）、慢性局部疼痛（ChRP）和纤维肌痛的患病率，并研究疼痛对疾病活动度和功能的影响。研究人员向1910名参加“更好的抗风湿病药物治疗研究”的患者发送了一份调查问卷。应答者（73%）根据报告的疼痛持续时间和分布分为无慢性疼痛（NChP）、慢性疼痛（ChWP）和慢性疼痛（ChRP） 3组。结果测量为28关节疾病活动度评分（DAS28）、健康评估问卷（HAQ）和c反应蛋白（CRP）。34%的受访者报告了ChWP， 46%的人报告了ChRP， 20%的人报告了NChP。报告ChWP的患者多为女性，纳入时疼痛和关节触痛较多。随访6个月至5年，ChWP组的平均DAS28、视觉模拟评分（VAS）疼痛、VAS整体健康状况和HAQ均显著高于其他组。然而，所有组在关节肿胀计数、红细胞沉降率（ESR）和CRP方面都表现出相似的模式。从12个月开始，ChWP组比ChRP组更大程度地使用泼尼松龙治疗，并且ChWP组与ChRP组的病情改善类抗风湿药物治疗率相似。ChWP是类风湿性关节炎的常见特征，与DAS28和HAQ等与疼痛相关的变量的高值相关，而与持续炎症的指标（如关节肿胀计数、ESR和CRP）的高值相关。应确定ChWP患者，以便对非炎症性疼痛也进行适当的治疗。
Objective. To study the prevalence of chronic widespread pain (ChWP), chronic regional pain (ChRP), and fibromyalgia in patients with early rheumatoid arthritis (RA) followed for 5 years after inclusion, and to study the effect of pain on measures of disease activity and function.Methods. A questionnaire was sent to 1910 patients participating in the Better Anti-Rheumatic Pharmacotherapy study. The responders (73%) were divided into 3 groups according to the reported pain duration and distribution patients having no chronic pain (NChP), ChWP, and ChRP. Outcome measures were the 28-joint Disease Activity Score (DAS28), the Health Assessment Questionnaire (HAQ), and C-reactive protein (CRP).Results. Thirty-four percent of respondents reported ChWP, 46% ChRP, and 20% NChP. Patients reporting ChWP were more often women and had more pain and tender joints at inclusion. From 6 months to 5 years of followup, mean DAS28, visual analog scale (VAS) pain, VAS global health, and HAQ were significantly higher in the ChWP group than in the other groups. However, all groups showed a similar pattern in swollen joint count, erythrocyte sedimentation rate (ESR), and CRP. From 12 months the ChWP group was treated with prednisolone to a greater extent than the ChRP group, and it had a rate of treatment with disease-modifying antirheumatic drugs similar to that of the ChRP group.Conclusion. ChWP is a common feature in RA, more associated with high values for variables related to pain such as the DAS28 and HAQ than to indicators of ongoing inflammation such as swollen joint count, ESR, and CRP. Patients with ChWP should be identified so that adequate treatment also of the noninflammatory pain may be instituted.