Implications of Persistent Pain in Patients With Rheumatoid Arthritis Despite Remission Status: Data From the KOBIO Registry

Abstract

Objective This study aimed to assess the prevalence of pain in patients with RA in clinical remission and analyze the demographic and clinical characteristics of those who experienced persistent pain despite remission status. Methods Data from 1,891 patients with RA registered on the Korean College of Rheumatology Biologics and Targeted Therapy registry were obtained. Remission was defined as a Disease Activity Score of 28 joints-erythrocyte sedimentation rate (ESR) <2.6. Pain intensity was classified as severe (pain visual analog scale [VAS] ≥7), moderate (4≤VAS<7), or mild (VAS <4). Results Our analysis showed that 52.6% of patients complained of severe pain at the start of or during switching biological disease-modifying anti-rheumatic drugs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs). Despite having a 36.0% (n=680) remission rate after the use of bDMARDs or tsDMARDs at their 1-year follow-up, 21.5% (n=146) of these patients had moderate-to-severe pain, higher frequency of foot erosions, and comorbidities, such as mental illness, endocrine, renal, and neurological disorders, than patients with a milder degree of pain. The multivariable regression analysis showed that presence of foot erosions, neurological disorders, and use of corticosteroids were independently associated with moderate-to-severe pain in patients with RA despite being in remission. The level of ESR and use of Janus kinase inhibitors were inversely associated with moderate-to-severe pain. Conclusion Persistent pain and discomfort continue to be a problem for patients with RA in clinical remission. Continued research on insistent pain in patients with RA is warranted to better alleviate distress and improve the quality of life in patients.

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“…Persistent pain is a significant issue for patients with RA, even in remission . The pain, often multifactorial, can be due to active inflammation, joint damage, or central pain regulation alterations .…”

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“…Foot discomfort is a major concern for patients with rheumatoid arthritis (RA), and nearly 90% of patients complain of foot pain during the course of disease [ 1 , 2 ]. These discomforts can occur during all periods of RA and have a huge impact on the patient’s daily life [ 3 ].…”

A Challenging Target: Persistent Pain During the Remission State in Rheumatoid Arthritis Patients

“…In this point, a study by Kim et al. [3] reported in the previous issue of the Journal of Rheumatic Diseases provides important implications of using a multidimensional approach to pain management in RA patients.…”

“…Despite recent advances in disease-modifying anti-rheumatic drugs (DMARDs) and the treat-to-target approaches for improved management of inflammation, rheumatologists often encounter patients in the clinic with complaints of moderate to severe pain [ 2 ]. In this point, a study by Kim et al [ 3 ] reported in the previous issue of the Journal of Rheumatic Diseases provides important implications of using a multi-dimensional approach to pain management in RA patients.…”

“…Using the Korean College of Rheumatology Biologics and Targeted Therapy (KOBIO) registry data, Kim et al [ 3 ] reported that 21.5% of RA patients complained of persistent moderate to severe pain despite clinical remission while being managed with biological or targeted synthetic DMARDs. Further, foot erosions, neurological disorders, and corticosteroid use were independent risk factors for moderate-to-severe pain in these patients on multivariate regression analysis.…”