Can the painDETECT Questionnaire score and MRI help predict treatment outcome in rheumatoid arthritis: protocol for the Frederiksberg hospital's Rheumatoid Arthritis, pain assessment and Medical Evaluation (FRAME-cohort) study

Abstract

Introduction Pain in rheumatoid arthritis (RA) is traditionally considered to be of inflammatory origin. Despite better control of inflammation, some patients still report pain as a significant concern, even when being in clinical remission. This suggests that RA may prompt central sensitisation—one aspect of chronic pain. In contrast, other patients report good treatment response, although imaging shows signs of inflammation, which could indicate a possible enhancement of descending pain inhibitory mechanisms. When assessing disease activity in patients with central sensitisation, the commonly used disease activity scores (eg, DAS28-CRP (C reactive protein)) will yield constant high total scores due to high tender joint count and global health assessments, whereas MRI provides an isolated estimate of inflammation. The objective of this study is, in patients with RA initiating anti-inflammatory treatment, to explore the prognostic value of a screening questionnaire for central sensitisation, hand inflammation assessed by conventional MRI, and the interaction between them regarding treatment outcome evaluated by clinical status (DAS28-CRP). For the purpose of further exploratory analyses, dynamic contrast-enhanced MRI (DCE-MRI) is performed. Method and analysis The painDETECT Questionnaire (PDQ), originally developed to screen for a neuropathic pain component, is applied to indicate the presence of central sensitisation. Adults diagnosed with RA are included when either (A) initiating disease-modifying antirheumatic drug treatment, or (B) initiating or switching to biological therapy. We anticipate that 100 patients will be enrolled, tested and reassessed after 4 months of treatment. Data collection includes Clinical data, conventional MRI, DCE-MRI, blood samples and patient-reported outcomes. Ethics and dissemination This study aims at supporting rheumatologists to define strategies to reach optimal treatment outcomes in patients with RA based on chronic pain prognostics. The study has been approved by The Capital region of Denmark's Ethics Committee; identification number H-3-2013-049. The results will be published in international peer-reviewed journals.

Comparison of Pain Characteristics in Patients with Rheumatoid Arthritis and Systemic Sclerosis with Particular Reference to the Neuropathic Pain Component: Cross-Sectional Study

“…Rifbjerg-Madsen et al [29] reported that non-nociceptive pain was very common in RA and was associated with higher scores of disease activity. A recently published study that assessed the NeP component in RA by the PainDetect questionnaire showed that medium and higher scores of NeP had poorer effects on depression, anxiety, fatigue, pain, and the mental component of HRQoL.…”

Rheumatic pain management: molecular aspects

“…Она ассоциируется со слабой активностью воспаления, о чем свидетельствуют низкие исходные уровни СОЭ и С-реактивного белка (СРБ) [96]. Более того, при наличии признаков центральной сенситизации (счет >19 по опроснику PainDETECT) прогнозируются негативные результаты терапии, оцениваемой по DAS28-СРБ [97]. С помощью определения экспрессии генов можно идентифицировать причины боли у отдельных больных РА на молекулярном уровне.…”

Upcoming value of gene expression analysis in rheumatology

“…Сохраняющаяся боль, несмотря на положительный клинический ответ, тесно связана с функциональной слабостью и инвалидностью [71], фибромиалгией [92] и слабой активностью воспаления, о чем свидетельствуют низкие уровни скорости оседания эритроцитов (СОЭ) и С-реактивного белка предшествующие терапии [93]. Более того, при уровнях показателя по опроснику, указывающему на центральную сенситизацию -PainDETECT превышающих 19, прогнозируются негативные результаты терапии, оцениваемой по клиническому показателю активности заболевания (DAS28-CRP) [94].…”