The course of pain hypersensitivity according to painDETECT in patients with rheumatoid arthritis initiating treatment: results from the prospective FRAME-cohort study

Abstract

BackgroundEvidence is emerging that pain in rheumatoid arthritis (RA) exists without underlying inflammation. Our objective was to evaluate the prognostic value of pain classification at treatment initiation using the painDETECT questionnaire (PDQ). Outcomes were change in DAS28-CRP and RAMRIS synovitis score.MethodsRA patients initiating a disease-modifying anti-rheumatic drug (DMARD) or initiating/ switching a biological agent were included. Follow-up time was 4 months. Clinical examination, imaging (MRI, dynamic contrast-enhanced MRI (DCE-MRI)), and patient-reported outcomes were undertaken. The PDQ was used to differentiate pain mechanisms. Mean change (95% CI) was calculated using ANCOVA. Multivariable regression models were used to determine a prognostic value.ResultsA total of 102 patients were included; 75 were enrolled for MRI. Mean changes in baseline variables were greatest in the high PDQ classification group (> 18), while limited in the intermediate group (13–18). The 12 patients with high baseline PDQ score all changed pain classification group. No prognostic value of PDQ pain classification was found in relation to change of DAS28-CRP, RAMRIS score, or VAS pain. In the unadjusted model, RAMRIS score at baseline was associated with change in DAS28-CRP. The exploratory variables of DCE-MRI did not differ from other inflammatory variables.ConclusionsIn RA patients a high PDQ score (non-nociceptive pain) at baseline was not associated with worse outcomes, in fact these patients had numerically greater improvement in DAS28-CRP. However, pain classification by PDQ was not independently associated with change in DAS28-CRP, RAMRIS score, or VAS pain in the prognostic models.Furthermore, patients classified with a high baseline PDQ score changed pain classification group. Patients with unclear pain mechanism had reduced numerically treatment response.Trial registrationThe study was approved by the Regional Ethics Committee of the Capital of Denmark April 18 2013; identification number H-3-2013-049.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1581-4) contains supplementary material, which is available to authorized users.

Pain in Rheumatoid Arthritis: Could JAK Inhibition be the Answer?

“… 44 In the prospective FRAME-cohort 102 RA patients were studied using clinical assessments, MRI hand imaging and PROs, including painDETECT, in order to evaluate the prognostic value of pain classification by the painDETECT score in relation to change in DAS28-CRP, VAS pain, and RAMRIS (MRI) score in RA patients initiating or escalating anti-inflammatory treatment. 45 No prognostic value of painDETECT pain classification was found in relation to change of DAS28-CRP, RAMRIS score, or VAS pain. Intriguingly a high painDETECT score (non-nociceptive pain) at baseline was not associated with worse outcomes, in fact these patients had numerically greater improvement in DAS28-CRP, ie, reversible inflammatory driven pain hypersensitivity.…”

Efficacy and safety of cannabidiol followed by an open label add-on of tetrahydrocannabinol for the treatment of chronic pain in patients with rheumatoid arthritis or ankylosing spondylitis: protocol for a multicentre, randomised, placebo-controlled study

“…The trial population is monitored regularly at the participating outpatient clinics and the individual longitudinal treatment is registered. DANBIO is the nationwide clinical quality database for rheumatology 16 29. All adult patients treated with biological drugs are registered.…”

“…Thus, chronic pain is likely to be due to peripheral joint and central neuropathic pain mechanisms at various stages 11–16…”

Contribution of neurogenic mechanisms to the pathogenesis of chronic joint pain

“…Таким инструментом, по нашему мнению, могут быть невропатические опросники в сочетании с неврологическим обследованием больных. В Российской Федерации на сегодняшний день валидизирован опросник DN4, в зарубежных странах более популярен опросник Pain DETECT из-за его психометрических возможностей, он применяется в сочетании с неврологическим осмотром для верификации состояния соматосенсорной системы и локализации чувствительных феноменов [28][29][30][31].…”