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Variability of Pain Levels Is Explained by Self-Reported Disease Activity in Rheumatoid [...]

Bailly, F., Jacquemin, C., Servy, H., Fautrel, B., Gossec, L. (June 2018)

Background Pain is a central characteristic of rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA), but it is multifactorial. Some patients describe high fluctuation of pain intensity, but fluctuation of pain and its association with disease activity has been little investigated.

Objectives To compare the variability of pain and of self-reported disease activity in patients with RA or axSpA through repeated assessments, and to describe clinical characteristics of patients with high variability of pain.

Methods Data were extracted from a prospective cohort study (ActConnect) including patients with clinician-confirmed RA or axSpA owning a smartphone.1 Baseline characteristics were collected. Over 3 months, weekly self-assessments of pain and patient global assessment of disease activity on 0–10 points numerical rating scales (NRS) were obtained. For each patient, the mean of the inter-assessment differences of NRS (average of absolute change – AAC) of pain and disease activity were calculated. RA and AxSpA patients were compared by t-test. High variability was defined as the upper tercile of AAC. Pearson’s correlation was used to evaluate the correlation between variability of pain and of self-reported disease activity. Univariate and multivariate logistic regression compared patients with high vs low variability of pain, without imputation of missing data, on R, including weekly self-reported flare over follow-up.

Results Eighty-six patients with RA and 79 with axSpA were included, mean age was respectively 48.7 (SD 12.7) and 41.7 (SD 10.2) years, mean disease duration was 8 (SD 8.8 and 8.6 respectively) years, 81% and 44% respectively were female. Mean DAS28 and BASDAI were respectively 2.27 (SD 1.18) and 3.21 (SD 2.06) at baseline; 44% and 62% respectively of patients were receiving a biologic.


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