Persistent and neuropathic pain occur frequently in rheumatoid arthritis, or RA, and tools that assess patient-reported outcomes can help clinicians determine the right care plan, according to the authors of a new study.
In what they said was the first prospective real-world study in patients with active RA and related pain, researchers sought to determine the proportion of RA patients who have severe persisting pain and ways to identify predictive factors.
They found that both persistent pain and neuropathic pain (from damage to nerves) are common in patients with RA, despite treatment with disease-modifying antirheumatic drugs, or DMARDs, and subsequent standard-of-care therapy. After 24 weeks of DMARD treatment, 23% of study participants continued to score 50 or higher (with higher numbers meaning more pain) on a pain visual analog scale, or VAS. This was despite improvements in disease activity scores and other signs of low disease activity, lead author Christoph Baerwald, of Leipzig University Hospital in Germany, and colleagues reported in Annals of Rheumatic Diseases.
Considering the study results, if patients consistently score in the upper half of a VAS, have a large number of tender joints or do not respond to DMARD therapy, and if other comorbidities have been excluded, they may have neuropathic pain and nociplastic pain, the researchers wrote. Nociplastic pain often is characterized by widespread pain without a clear identifiable tissue damage.
The study authors recommend that clinicians determine patient-reported outcomes with tools such as the Rheumatoid Arthritis Impact of Disease Questionnaire, or RAID, or the painDETECT Questionnaire, or PD-Q, to help facilitate patient-physician communication when anti-inflammatory treatment does not alleviate symptoms.
“These tools may be considered as a starting point for further diagnostic procedures and planning of tailored treatment following underlying pain mechanisms,” they concluded.
