Pain is the main concern of patients with rheumatoid arthritis (RA) while reducing disease activity dominates specialist management. Disease activity assessments like the disease activity score for 28 joints with the erythrocyte sedimentation rate (DAS28-ESR) omit pain creating an apparent paradox between patients’ concerns and specialists’ treatment goals. We evaluated the relationship of pain intensity and disease activity in RA with three aims: defining associations between pain intensity and disease activity and its components, evaluating discordance between pain intensity and disease activity, and assessing temporal changes in pain intensity and disease activity. We undertook secondary analyses of five trials and one observational study of RA patients followed for 12 months. The patients had early and established active disease or sustained low disease activity or remission. Pain was measured using 100-mm visual analogue scales. Individual patient data was pooled across all studies and by types of patients (early active, established active and established remission). Associations of pain intensity and disease activity were evaluated by correlations (Spearman’s), linear regression methods and Bland-Altman plots. Discordance was assessed by Kappa statistics (for patients grouped into high and low pain intensity and disease activity). Temporal changes were assessed 6 monthly in different patient groups. A total of 1132 patients were studied: 490 had early active RA, 469 had established active RA and 173 were in remission/low disease activity. Our analyses showed, firstly, that pain intensity is associated with disease activity in general, and particularly with patient global assessments, across all patient groups. Patient global assessments were a reasonable proxy for pain intensity. Secondly, there was some discordance between pain intensity and disease activity across all disease activity levels, reflecting similar discrepancies in patient global assessments. Thirdly, there were strong temporal relationships between changes in disease activity and pain intensity. When mean disease activity fell, mean pain intensity scores also fell; when mean disease activity increased, there were comparable increases in pain intensity. These findings show pain intensity is an integral part of disease activity, though it is not measured directly in DAS28-ESR. Reducing disease activity is crucial for reducing pain intensity in RA.

中文翻译：

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确定类风湿性关节炎患者疼痛强度与疾病活动度之间的关系：六项研究的二次分析

疼痛是类风湿关节炎 (RA) 患者的主要关注点，而减少疾病活动则主导着专科治疗。像红细胞沉降率 (DAS28-ESR) 的 28 个关节的疾病活动评分等疾病活动评估忽略了疼痛，从而在患者的担忧和专家的治疗目标之间产生了明显的矛盾。我们评估了 RA 中疼痛强度和疾病活动的关系，目的有三个：确定疼痛强度和疾病活动及其成分之间的关​​联，评估疼痛强度和疾病活动之间的不一致，以及评估疼痛强度和疾病活动的时间变化。我们对五项试验和一项对 RA 患者的观察性研究进行了二次分析，随访时间为 12 个月。患者有早期和确定的活动性疾病或持续的低疾病活动或缓解。使用 100 毫米视觉模拟量表测量疼痛。在所有研究和患者类型（早期活动、确定活动和确定缓解）中汇总了个体患者数据。通过相关性（Spearman's）、线性回归方法和 Bland-Altman 图评估疼痛强度和疾病活动的关联。通过 Kappa 统计数据评估不一致（针对分为高、低疼痛强度和疾病活动的患者）。在不同的患者组中，每 6 个月评估一次时间变化。共研究了 1132 名患者：490 名早期活动性 RA，469 名活动性 RA，173 名处于缓解/低疾病活动状态。我们的分析表明，首先，总体而言，疼痛强度与疾病活动有关，特别是与所有患者组的患者整体评估有关。患者整体评估是疼痛强度的合理替代指标。其次，所有疾病活动水平的疼痛强度和疾病活动之间存在一些不一致，这反映了患者总体评估中的类似差异。第三，疾病活动的变化与疼痛强度之间存在很强的时间关系。当平均疾病活动度下降时，平均疼痛强度评分也下降；当平均疾病活动增加时，疼痛强度也有相当的增加。这些发现表明疼痛强度是疾病活动的一个组成部分，尽管它不是直接在 DAS28-ESR 中测量的。减少疾病活动对于降低 RA 的疼痛强度至关重要。