In well-controlled rheumatoid arthritis (RA) without significant joint damage, a substantial proportion of patients complain of persistent pain. Previous studies have identified different pain phenotypes in RA, in which non-nociceptive pain phenotypes are associated with higher concurrent disease activity scores. In this longitudinal study, we explored associations between pain phenotypes and long-term disease activity outcome in RA patients. Secondly, we explored whether pain phenotype is associated with comorbid conditions. One hundred eighty established RA patients were classified with a nociceptive (61%) or a non-nociceptive (39%) pain phenotype, based on their responses to the painDETECT-questionnaire. Two years of clinical follow-up data on disease activity outcomes were collected. Information on comorbid diseases was derived from electronic patient files. Patients with a non-nociceptive pain phenotype showed higher mean disease activity scores (DAS28, 2.57; 95% CI, 2.37–2.77 vs. 2.11; 95% CI, 1.94–2.27; p < 0.001) and a twofold lower chance of achieving sustained DAS28 remission (OR = 0.49; 95% CI, 0.26–0.92; p = 0.020). Only the tender joint count and patient global health significantly differed between the pain phenotype groups. Patients with a non-nociceptive pain phenotype had more often been diagnosed with concurrent fibromyalgia (9.9% vs. 0.9%; p = 0.007) and other pain-associated comorbid diseases (52.1% vs. 35.8%; p = 0.030) compared with patients with a nociceptive pain phenotype. This longitudinal study showed consistently worse long-term disease activity outcomes in RA patients with a non-nociceptive pain phenotype which appeared to be mainly due to differences in the subjective components of the disease activity score. The DREAM cohort study is registered in the Netherlands Trial Register: NTR578.

中文翻译：

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类风湿关节炎患者疼痛表型与疾病活动之间的关联：一项非干预性纵向队列研究。

在良好控制的类风湿关节炎（RA）中，没有明显的关节损伤，很大一部分患者抱怨持续疼痛。先前的研究已经确定了RA中不同的疼痛表型，其中非伤害性疼痛表型与较高的并发疾病活动性评分相关。在这项纵向研究中，我们探讨了RA患者的疼痛表型与长期疾病活动性结局之间的关联。其次，我们探讨了疼痛表型是否与合并症相关。根据对疼痛DETECT问卷的反应，将一百八十名确诊为RA的患者分类为伤害性（61％）或非伤害性（39％）的疼痛表型。收集了有关疾病活动结局的两年临床随访数据。有关合并症的信息来自电子病历。具有非伤害性疼痛表型的患者表现出较高的平均疾病活动评分（DAS28，2.57； 95％CI，2.37–2.77比2.11； 95％CI，1.94–2.27； p <0.001），并且获得持续性疾病的机会降低了两倍DAS28缓解（OR = 0.49； 95％CI，0.26-0.92； p = 0.020）。在疼痛表型组之间，只有压痛关节计数和患者整体健康状况显着不同。与患者相比，具有非伤害性疼痛表型的患者更常被诊断为并发纤维肌痛（9.9％vs. 0.9％； p = 0.007）和其他与疼痛相关的合并症（52.1％vs. 35.8％； p = 0.030）。具有伤害性疼痛表型。这项纵向研究显示，在非伤害性疼痛表型的RA患者中，长期疾病活动性结果持续恶化，这似乎主要是由于疾病活动性评分的主观成分不同所致。DREAM队列研究已在荷兰试验注册处注册：NTR578。