To determine the prevalence of chronic back pain and its changes over 5 years in patients with RA compared with community controls and to evaluate the influence of chronic back pain in functional capacity, general pain and global health.
The prevalence of chronic back pain in 1076 patients with RA and in 1491 community controls was evaluated using a mailed questionnaire, which also queried the functional capacity on the HAQ, and general pain and global health on visual analogue scales.
Chronic back pain was more frequent in the general population than in patients with RA: 19% of patients with RA and 25% of controls reported chronic back pain (P < 0.001). After 5 years, 57% of these patients initally reporting pain and 58% of controls still reported chronic back pain. In community controls with and without chronic back pain, the median HAQ, general pain and global health were 0.13 vs 0.00, 28 vs 6 and 28 vs 11, respectively (P < 0.001). The figures were 0.88 vs 0.63 (P = 0.05), 42 vs 26 and 42 vs 30 (P < 0.001), respectively, in patients with RA. All analyses were adjusted for age and sex.
Chronic back pain does not occur more frequently in patients with RA than in the general population. Almost 60% of patients and controls who reported chronic back pain still reported it 5 years later. In patients with RA and in the control population, subjects with chronic back pain had worse functional capacity, general pain and global health.
"The prevalence of LBP in patients with RA has been reported as 33–40%   . LBP has been reported to be associated with factors such as; inflammation, disease activity and medications in these small number of studies   . Those with co-occurring LBP were found to have significantly lower physical functioning scores and quality of life than RA patients without LBP [3,10–12]. "
[Show abstract][Hide abstract] ABSTRACT: Aim of the work: The purpose of this study was to investigate the rheumatoid arthritis (RA) characteristics, functional capacity, depression and anxiety as well as quality of life (QoL) in RA patients with chronic radicular low back and leg pain diagnosis which was determined by using electroneuromyographic (ENMG) evaluation. Patients and methods: In this study, 32 female RA patients with radicular low back and leg pain for at least 3. months were recruited. Electroneuromyographic (ENMG) evaluation was performed in all patients and accordingly grouped: group 1: normal ENMG (n= 7; 22%), group 2: patients with polyneuropathy (n= 8; 25%) and group 3: patients with radiculopathy (n= 17; 53%). Disease activity was assessed by disease activity score (DAS28) and functional disability by modified Health Assessment Questionnaire (mHAQ). Arthritis Impact Measurement Scale-2 was used to assess QoL and Beck Inventory for assessment of anxiety and depression. Results: The mean age of the patients was 54.7. ± 10.3. years and disease duration 14.9. ± 8.3. years. The DAS-28 and functional disability were significantly increased (p= 0.005 and p= 0.01) in group-2 compared to the other groups. There were no significant differences in the depression and anxiety scores among the 3 groups. Significantly impaired QoL parameters (Hand-finger function, arm function, social activity and pain) were present in the polyneuropathy group. There was no difference in assessment parameters between the normal and radiculopathy groups. Conclusions: Chronic radicular low back and leg pain in patients with RA may be due to probable lumbar radiculopathy as well as an indicator for polyneuropathy.
[Show abstract][Hide abstract] ABSTRACT: To investigate what factors influence patient global health assessment (PtGlobal), and how those factors and the reliability of PtGlobal affect the rate, reliability, and validity of recently published American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria when used in clinical practice.
We examined consecutive patients with RA in clinical practice and identified 77 who met ACR/EULAR joint criteria for remission (≤ 1 swollen joint and ≤ 1 tender joint). We evaluated factors associated with a PtGlobal > 1, because a PtGlobal ≤ 1 defined ACR/EULAR remission in this group of patients who had already met ACR/EULAR joint criteria.
Of the 77 patients examined, only 17 (22.1%) had PtGlobal ≤ 1 and thus fully satisfied ACR/EULAR criteria. A large proportion of patients not in remission by ACR/EULAR criteria had high PtGlobal related to noninflammatory issues, including low back pain, fatigue, and functional limitations, and a number of patients clustered in the range of PtGlobal > 1 and ≤ 2. However, the minimal detectable difference for PtGlobal was 2.3. In addition, compared with a PtGlobal severity score, a PtGlobal activity score was 3.3% less likely to be abnormal (> 1).
Noninflammatory factors contribute to the level of PtGlobal and result in the exclusion of many patients who would otherwise be in "true" remission according to the ACR/EULAR definition. Reliability problems associated with PtGlobal can also result in misclassification, and may explain the observation of low longterm remission rates in RA. As currently constituted, the use of the ACR/EULAR remission criteria in clinical practice appears to be problematic.
The Journal of Rheumatology 05/2012; 39(6):1139-45. DOI:10.3899/jrheum.111543 · 3.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT The objective of this study was to assess recent data on the prevalence of chronic pain as part of chronic diseases; the prevalence of chronic pain as a chronic condition in its own right; the costs attributed to chronic pain; and the European Union (EU) policies to addressing chronic pain. Recent literature was reviewed for data on the prevalence and cost implications of chronic pain in the EU. Following on from an earlier systematic review, 8 databases were searched for prevalence and 10 for cost information from 2009 to 2011 and relevant EU organizations were contacted. Ten cost and 29 prevalence studies were included from the 142 full papers screened. The general adult population reported an average chronic pain prevalence of 27%, which was similar to those for common chronic conditions. Fibromyalgia had the highest unemployment rate (6%; Rivera et al., Clin Exp Rheumatol. 2009;27[Suppl 56]:S39-S45) claims for incapacity benefit (up to 29.9%; Sicras-Mainar et al., Arthritis Res Ther. 2009;11:R54), and greatest number of days of absence from work (Rivera et al., Clin Exp Rheumatol. 2009;27[Suppl 56]:S39-S45). Chronic pain is common and the total population cost is high. Despite its high impact, chronic pain as a condition seems to have had little specific policy response. However, there does appear to be sufficient evidence to at least make addressing chronic pain a high priority alongside other chronic diseases as well as to conduct more research, particularly regarding cost.
Journal of Pain & Palliative Care Pharmacotherapy 12/2012; 26(4):310-325. DOI:10.3109/15360288.2012.736933
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