Pain and pain mechanisms in patients with inflammatory arthritis: A Danish nationwide cross-sectional DANBIO registry survey

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Central pain mechanisms may be prominent in subsets of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and other spondyloarthritis (SpA). The painDETECT questionnaire (PDQ) identifies neuropathic pain features, which may act as a proxy for centrally mediated pain.

The objectives were to quantify and characterize pain phenotypes (non-neuropathic vs. neuropathic features) among Danish arthritis patients using the PDQ, and to assess the association with on-going inflammation.

Methods

The PDQ was included onto the DANBIO touch screens at 22 departments of Rheumatology in Denmark for six months. Clinical data and patient reported outcomes were obtained from DANBIO. A PDQ-score >18 indicated neuropathic pain features, 13–18 unclear pain mechanism and <13 non-neuropathic pain.

Results

Pain data (visual analogue scale, VAS) was available for 15,978 patients. 7,054 patients completed the PDQ (RA: 3,826, PsA: 1,180, SpA: 1,093). 52% of all patients and 63% of PDQ-completers had VAS pain score ≥ 30 mm. The distribution of the PDQ classification-groups (<13/ 13-18/ >18) were; RA: 56%/24%/20%. PsA: 45%/ 27%/ 28%. SpA: 55% / 24%/ 21%. More patients with PsA had PDQ score >18 compared to RA and SpA (p<0.001). For PDQ > 18 significantly higher scores were found for all patient reported outcomes and disease activity scores. No clinical difference in CRP or swollen joint count was found. Logistic regression showed increased odds for having VAS pain ≥39 mm (the median) for a PDQ-score >18 compared to <13 (OR = 10.4; 95%CI 8.6–12.5).

Conclusions

More than 50% of the Danish arthritis patients reported clinically significant pain. More than 20% of the PDQ-completers had indication of neuropathic pain features, which was related to a high pain-level. PDQ-score was associated with DAS28-CRP and VAS pain but not with indicators of peripheral inflammation (CRP and SJC). Thus, pain classification by PDQ may assist in mechanism-based pain treatment.

Related collections

Most cited references 33

Record: found
Abstract: found
Article: not found

Minimum clinically important improvement and patient acceptable symptom state in pain and function in rheumatoid arthritis, ankylosing spondylitis, chronic back pain, hand osteoarthritis, and hip and knee osteoarthritis: Results from a prospective multinational study.

N Bellamy, Maria Cepero, Robrecht van der Wel … (2012)

To estimate the minimum clinically important improvement (MCII) and patient acceptable symptom state (PASS) values for 4 generic outcomes in 5 rheumatic diseases and 7 countries. We conducted a multinational (Australia, France, Italy, Lebanon, Morocco, Spain, and The Netherlands) 4-week cohort study involving 1,532 patients who were prescribed nonsteroidal antiinflammatory drugs for ankylosing spondylitis, chronic back pain, hand osteoarthritis, hip and/or knee osteoarthritis, or rheumatoid arthritis. The MCII and PASS values were estimated with the 75th percentile approach for 4 generic outcomes: pain, patient global assessment, functional disability, and physician global assessment, all normalized to a 0-100 score. For the whole sample, the estimated MCII values for absolute change at 4 weeks were -17 (95% confidence interval [95% CI] -18, -15) for pain; -15 (95% CI -16, -14) for patient global assessment; -12 (95% CI -13, -11) for functional disability assessment; and -14 (95% CI -15, -14) for physician global assessment. For the whole sample, the estimated PASS values were 42 (95% CI 40, 44) for pain; 43 (95% CI 41, 45) for patient global assessment; 43 (95% CI 41, 44) for functional disability assessment; and 39 (95% CI 37, 40) for physician global assessment. Estimates were consistent across diseases and countries (for subgroups ≥20 patients). This work allows for promoting the use of values of MCII (15 of 100 for absolute improvement, 20% for relative improvement) and PASS (40 of 100) in reporting the results of trials of any of the 5 involved rheumatic diseases with pain, patient global assessment, physical function, or physician global assessment used as outcome criteria. Copyright © 2012 by the American College of Rheumatology.

0 comments Cited 140 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis.

G. Hawker, L Gagliese, J Hochman … (2013)

Clinical tools are needed to identify and target a neuropathic-like phenotype, which may be associated with central sensitization (CS), in osteoarthritis (OA). The modified painDETECT questionnaire (mPD-Q) has face and content validity for identifying neuropathic-like symptoms in knee OA. To further validate the mPD-Q, this study assessed the unknown relationship between mPD-Q scores and signs of CS on quantitative sensory testing (QST) in knee OA. 36 Individuals were recruited with chronic, symptomatic, knee OA without other pain/neurological conditions. Reference QST data were obtained from 18 controls/32 eligible knees, enabling identification of sensory abnormalities/CS among case knees. A standardized questionnaire assessed psychological factors (depressive symptoms and pain catastrophizing), and for individual knees, mPD-Q and pain intensity scores. A standardized/comprehensive QST protocol was conducted for each knee. QST signs of CS were defined as: mechanical hyperalgesia and/or enhanced temporal summation and/or allodynia. The relationship between the presence of CS (yes/no) and a pre-selected mPD-Q score (≤12 or >12), by knees, was assessed using generalized estimating equations. Among 57 eligible case knees, 45.6% had ≥1 sign of CS. Controlling for age, knees with higher mPD-Q scores (>12.0) had higher odds of having QST signs of CS (adjusted odds ratio (OR) = 5.6; 95% confidence interval (CI), 1.3-22.9). This relationship was unaffected by controlling for depression and pain intensity, but was attenuated by pain catastrophizing. Among painful OA knees, higher mPD-Q scores were associated with greater odds of having signs of CS. Thus, the mPD-Q may aid the identification of CS in people with chronic knee OA. © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

0 comments Cited 101 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: a longitudinal observational study

Yvonne Lee, Jing-Jing Cui, Yao-bing Lu … (2011)

Introduction Disease remission has become a feasible goal for most rheumatoid arthritis (RA) patients; however, patient-reported symptoms, such as pain, may persist despite remission. We assessed the prevalence of pain in RA patients in remission according to the Disease Activity Score (DAS28-CRP4) and the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria. Methods Data were analyzed from RA patients in the Brigham Rheumatoid Arthritis Sequential Study with data at baseline and 1 year. DAS28 remission was defined as DAS28-CRP4 <2.6. The ACR/EULAR remission criteria included (a) one or more swollen joints, (b) one or more tender joints, (c) C-reactive protein ≤1 mg/dl, and (d) patient global assessment score ≤1. Pain severity was measured by using the pain score from the Multi-Dimensional Health Assessment Questionnaire (MDHAQ). The associations between baseline clinical predictors and MDHAQ pain at baseline and 1 year were assessed by using multivariable linear regression. Results Among the 865 patients with data at baseline and 1 year, 157 (18.2%) met DAS28-CRP4 remission criteria at both time points. Thirty-seven (4.3%) met the ACR/EULAR remission criteria at baseline and 1 year. The prevalence of clinically significant pain (MDHAQ pain ≥4) at baseline ranged from 11.9% among patients meeting DAS28-CRP4 remission criteria to none among patients meeting ACR/EULAR remission criteria. Patient global assessment, MDHAQ function, MDHAQ fatigue, MDHAQ sleep, and arthritis self-efficacy were significantly associated with MDHAQ pain in cross-sectional (P ≤ 0.0005) and longitudinal analyses (P ≤ 0.03). Low swollen-joint counts were associated with high MDHAQ pain in longitudinal analyses (P = 0.02) but not cross-sectional analyses. Other measures of inflammatory disease activity and joint damage were not significantly associated with MDHAQ pain at baseline or at 1 year. Conclusions Clinically significant pain continues among a substantial proportion of patients in DAS28 remission but not among those in ACR/EULAR remission. Among patients in DAS28 remission, patient global assessment, disability, fatigue, sleep problems, and self-efficacy are strongly associated with pain severity at baseline and 1 year, whereas inflammatory disease activity and joint damage are not significantly associated with elevated pain severity at either baseline or 1 year.

0 comments Cited 86 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

S. Rifbjerg-Madsen:

ORCID: http://orcid.org/0000-0002-1491-6664

Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

A. W. Christensen: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

R. Christensen: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

M. L. Hetland: Role: MethodologyRole: SupervisionRole: Writing – original draft

H. Bliddal: Role: ConceptualizationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

L. E. Kristensen: Role: Writing – original draftRole: Writing – review & editing

B. Danneskiold-Samsøe: Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

K. Amris: Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: Writing – original draftRole: Writing – review & editing

Peter M ten Klooster: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 7 July 2017

Publication date Collection: 2017

Volume: 12

Issue: 7

Electronic Location Identifier: e0180014

Affiliations

[1 ]The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, Denmark

[2 ]DANBIO, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark

[3 ]Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

[4 ]Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, Denmark

University of Twente, NETHERLANDS

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: PARKER.Frederiksberg@ 123456regionh.dk

Author information

S. Rifbjerg-Madsen http://orcid.org/0000-0002-1491-6664

Article

Publisher ID: PONE-D-16-21054

DOI: 10.1371/journal.pone.0180014

PMC ID: 5501437

PubMed ID: 28686639

SO-VID: de2e225f-cbc0-4757-8d4a-4c044a29d5aa

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 25 May 2016

Date accepted : 7 June 2017

Page count

Figures: 2, Tables: 4, Pages: 16

Funding

Funded by: Selsbjerg Holding

Award Recipient :

ORCID: http://orcid.org/0000-0002-1491-6664

Signe Rifbjerg-Madsen

Funded by: The Danish Rheumatism Association

Award Recipient :

ORCID: http://orcid.org/0000-0002-1491-6664

Signe Rifbjerg-Madsen

Funded by: Minister Erna Hamiltons Legat for Videnskab og Kunst

Award Recipient :

ORCID: http://orcid.org/0000-0002-1491-6664

Signe Rifbjerg-Madsen

Funded by: Axel Muusfeldts Fond

Award Recipient :

ORCID: http://orcid.org/0000-0002-1491-6664

Signe Rifbjerg-Madsen

Funded by: funder-id http://dx.doi.org/10.13039/100007403, Dagmar Marshalls Fond;

Award Recipient :

ORCID: http://orcid.org/0000-0002-1491-6664

Signe Rifbjerg-Madsen

Funded by: Region Hovedstadens Forskningsfond

Award Recipient :

ORCID: http://orcid.org/0000-0002-1491-6664

Signe Rifbjerg-Madsen

Funded by: Bjarne Jensens Fond

Award Recipient :

ORCID: http://orcid.org/0000-0002-1491-6664

Signe Rifbjerg-Madsen

Funded by: The Oak Foundation

Award Recipient :

ORCID: http://orcid.org/0000-0002-1491-6664

Signe Rifbjerg-Madsen

SRM recieved grants from Selsbjerg Holding, The Danish Rheumatism Association, Minister Erna Hamiltons Legat for Videnskab og Kunst, Axel Muusfeldts Fond, Dagmar Marshalls Fond, Region Hovedstadens Forskningsfond, Bjarne Jensens Fond, and The Oak Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability Data are available from the Danish national rheumatolgic quality registry, DANBIO, for researchers who meet the Danish legal criteria for access to confidential data. Contact: databasen@ 123456danbio-online.dk or www.rkkp.dk.

Pain and pain mechanisms in patients with inflammatory arthritis: A Danish nationwide cross-sectional DANBIO registry survey

Read this article at

Abstract

Background

Methods

Results

Conclusions

Related collections

PLOS Climate

Most cited references 33

Minimum clinically important improvement and patient acceptable symptom state in pain and function in rheumatoid arthritis, ankylosing spondylitis, chronic back pain, hand osteoarthritis, and hip and knee osteoarthritis: Results from a prospective multinational study.

Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis.

Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: a longitudinal observational study

Author and article information

Contributors

Journal

Affiliations

Author notes

Author information

Article

History

Page count

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 254

Cited by 36

Most referenced authors 544