Pain phenotyping for explaining treatment outcomes in rheumatoid arthritis patients.

Graaf, N. de (2017) Pain phenotyping for explaining treatment outcomes in rheumatoid arthritis patients. thesis, Medicine.

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Abstract

Introduction: Rheumatoid arthritis (RA) is a systemic joint disease, with joint pain as the predominant impairment. Despite it is a well-controlled disease, nearly 20% of the patients complain about persistent pain, in which central sensitization may play a significant role. Pain can adversely affect treatment outcomes. Comorbid diseases might influence treatment outcomes as well. In this longitudinal study, we explored the association between different pain phenotypes and long-term treatment outcomes in RA patients. Method: 180 RA patients were categorized in a nociceptive (NoP, 61%) or a non-nociceptive (NoNoP, 39%) pain phenotype, based on the painDETECT-questionnaire. The patient’s baseline data (e.g. patient characteristics, quality of life, disease activity and medication use) were linked with two years of clinical follow-up data on treatment outcomes. Information about baseline comorbid diseases was derived from the electronic patient files. Results: Patients with NoNoP were more frequently presented with fibromyalgia (9.9% vs 0.9% p=0.007) and other pain associated comorbid diseases (52.1% vs 35.8%, p=0.030) compared to patients with NoP. NoNoP showed a slightly higher mean disease activity score (DAS-28 2.55±0.87 vs. 2.14±0.85; p=0.002) and a two-fold decreased chance of achieving sustained remission (OR=0.49; 95%CI=0.26-0.92, p=0.020) during follow-up. There was however, no difference in the usage of painkillers or anti-rheumatic drugs between the pain phenotypes. In univariate analyses, the pain phenotypes were explanatory for both the average DAS-28 follow-up score and for achieving sustained remission. However, this explanatory value disappeared in multivariate regression models, after correcting for baseline disease activity, pain associated comorbidities and disability. Conclusion: This longitudinal study showed worse long-term treatment outcomes in RA patients with a non-nociceptive pain phenotype, compared to RA patients with a nociceptive pain phenotype. However, these pain phenotypes did not have an explanatory value on treatment outcomes over and above other already known clinical variables, according to multivariate regression analyses. Further research into identifying pain phenotypes in RA patients is needed to contribute to more efficient and personalized treatments.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Vonkeman, dr. H.E. and rheumatologist
Supervisor name:	External supervisor: and Klooster, dr. P.M. ten and Location: Medisch Spectrum Twente and Department: Rheumatology and Clinical Immunology and The Arthritis Center Twente
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:56
Last Modified:	25 Jun 2020 10:56
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1647

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