Chronic back pain in patients with rheumatoid arthritis and in a control population: prevalence and disability--a 5-year follow-up.
ABSTRACT 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.
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ABSTRACT: The aim of this study was to assess the point prevalence of low back pain (LBP) in patients with rheumatoid arthritis (RA); and to compare radiological and clinical aspects, as well as impact of LBP on health related quality of life (QoL), depression and disability in control patients with mechanical LBP (mLBP). Patients with RA and patients with mLBP of at least 3 months duration were consecutively recruited. All patients were examined and underwent lumbar X-ray and magnetic resonance (MR) imaging. Disc intensity, annulus fibrosis rupture, herniated nucleus pulposus (bulging, protrusion, extrusion or sequestration), stenosis, Schmorl nodes, hemangiomas, Tarlow cysts, Type I or II degeneration, ligamentum flavum hypertrophy and loss of lordosis were assessed on MR. Assessments included QoL and disability scales like RAQoL, Short Form-36, Health Assessment Questionnaire (HAQ) and Oswestry Disability Index (ODI) and depression and anxiety scales as well. Chronic LBP coexisted in 64.5% of patients with RA. Patients with LBP had higher scores on VAS-LBP compared to patients with RA+LBP. Additionally, patients with RA+LBP had the poorest scores on quality of life, functional disability and depression. Patients with mLBP had more frequent clinical manifestations and neurologic deficits. Patients with RA+LBP had more frequent Schmorl nodes compared to patients with mLBP. The association of RA with LBP leads to a significant decrease in the functional capacity and QoL as well as increase in depression risk. Appropriate diagnostic procedures and treatments should be administered to avoid further deterioration in functional disability and QoL.Journal of Back and Musculoskeletal Rehabilitation 03/2013; · 1.04 Impact Factor
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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.
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ABSTRACT: Pain is the most common reason patients with inflammatory arthritis see a rheumatologist. Patients consistently rate pain as one of their highest priorities, and pain is the single most important determinant of patient global assessment of disease activity. Although pain is commonly interpreted as a marker of inflammation, the correlation between pain intensity and measures of peripheral inflammation is imperfect. The prevalence of chronic, non-inflammatory pain syndromes such as fibromyalgia is higher among patients with inflammatory arthritis than in the general population. Inflammatory arthritis patients with fibromyalgia have higher measures of disease activity and lower quality of life than inflammatory patients who do not have fibromyalgia. This review article focuses on current literature involving the effects of pain on disease assessment and quality of life for patients with inflammatory arthritis. It also reviews non-pharmacologic and pharmacologic options for treatment of pain for patients with inflammatory arthritis, focusing on the implications of comorbidities and concurrent disease-modifying antirheumatic drug therapy. Although several studies have examined the effects of reducing inflammation for patients with inflammatory arthritis, very few clinical trials have examined the safety and efficacy of treatment directed specifically towards pain pathways. Most studies have been small, have focused on rheumatoid arthritis or mixed populations (e.g., rheumatoid arthritis plus osteoarthritis), and have been at high risk of bias. Larger, longitudinal studies are needed to examine the mechanisms of pain in inflammatory arthritis and to determine the safety and efficacy of analgesic medications in this specific patient population.Current Rheumatology Reports 01/2013; 15(1):300. · 2.45 Impact Factor