ACR 2020 | Daily Highlights

Pain and disease activity

ASSOCIATION BETWEEN CHANGES IN PAIN SENSITIZATION AND CHANGES IN DISEASE ACTIVITY AFTER 12 WEEKS OF DISEASE MODIFYING ANTI-RHEUMATIC DRUG THERAPY IN RHEUMATOID ARTHRITIS

Abstract: 0022
Authors: Andrew Heisler et al.

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Key content:
A substantial proportion of patients with RA or SLE also display some degree of central sensitization with widespread pain distribution, which we would describe as concomitant fibromyalgia as clinicians. Pain sensitization is clinically relevant because the increased patient-reported pain and joint tenderness, which makes reaching treatment objectives of remission or low disease activity more difficult. The authors explore whether treatment with disease modifying anti-rheumatic drugs (DMARDs) would modify pain sensitization. The 236 RA patients participating in this study underwent quantitative sensory testing (QST) to assess pressure pain thresholds (PPTs), and standard disease activity score in 28 joints (DAS28-CRP) to measure disease activity. After initiating DMARD therapy, measures of pain sensitivity decreased, - however not as much as the DAS28-CRP. Overall, the results of this study suggest that treatment with DMARDs alone may not be sufficient to address pain sensitization in RA.

Relevance:
Traditionally, rheumatologist have focused on reducing the inflammatory activity of RA and in preventing permanent joint damage. It is well established that patients’ wellbeing is more dependent on pain levels than on disease activity. In a substantial proportion of our patients treating inflammation alone will not be enough to ensure acceptable levels of pain. Instead of switching to yet another DMARD, it may sometimes be more adequate to help patients work on their pain threshold with adequate medications and with adapted physical activity.

Zusammenfassung und Kommentar von:
Prof. Dr. Axel Finckh
Genf