The course of pain hypersensitivity according to painDETECT in patients with rheumatoid arthritis initiating treatment: results from the prospective FRAME-cohort study

Signe Rifbjerg-Madsen, Anton Wulf Christensen, Mikael Boesen, Robin Christensen, Bente Danneskiold-Samsøe, Henning Bliddal, Lene Dreyer, Henning Locht, Kirstine Amris

Research output: Contribution to journalJournal articleResearchpeer-review

15 Downloads (Pure)

Abstract

BACKGROUND: Evidence is emerging that pain in rheumatoid arthritis (RA) exists without underlying inflammation. Our objective was to evaluate the prognostic value of pain classification at treatment initiation using the painDETECT questionnaire (PDQ). Outcomes were change in DAS28-CRP and RAMRIS synovitis score.

METHODS: RA patients initiating a disease-modifying anti-rheumatic drug (DMARD) or initiating/ switching a biological agent were included. Follow-up time was 4 months. Clinical examination, imaging (MRI, dynamic contrast-enhanced MRI (DCE-MRI)), and patient-reported outcomes were undertaken. The PDQ was used to differentiate pain mechanisms. Mean change (95% CI) was calculated using ANCOVA. Multivariable regression models were used to determine a prognostic value.

RESULTS: A total of 102 patients were included; 75 were enrolled for MRI. Mean changes in baseline variables were greatest in the high PDQ classification group (> 18), while limited in the intermediate group (13-18). The 12 patients with high baseline PDQ score all changed pain classification group. No prognostic value of PDQ pain classification was found in relation to change of DAS28-CRP, RAMRIS score, or VAS pain. In the unadjusted model, RAMRIS score at baseline was associated with change in DAS28-CRP. The exploratory variables of DCE-MRI did not differ from other inflammatory variables.

CONCLUSIONS: In RA patients a high PDQ score (non-nociceptive pain) at baseline was not associated with worse outcomes, in fact these patients had numerically greater improvement in DAS28-CRP. However, pain classification by PDQ was not independently associated with change in DAS28-CRP, RAMRIS score, or VAS pain in the prognostic models. Furthermore, patients classified with a high baseline PDQ score changed pain classification group. Patients with unclear pain mechanism had reduced numerically treatment response.

TRIAL REGISTRATION: The study was approved by the Regional Ethics Committee of the Capital of Denmark April 18 2013; identification number H-3-2013-049 .

Original languageEnglish
Article number105
JournalArthritis Research & Therapy
Volume20
Number of pages11
ISSN1478-6354
DOIs
Publication statusPublished - 30. May 2018
Externally publishedYes

Fingerprint

Hypersensitivity
Cohort Studies
Ethics Committees
Antirheumatic Agents
Surveys and Questionnaires
Denmark

Keywords

  • Central sensitization
  • Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)
  • PainDETECT questionnaire
  • Prognostics
  • Rheumatoid arthritis

Cite this

Rifbjerg-Madsen, Signe ; Christensen, Anton Wulf ; Boesen, Mikael ; Christensen, Robin ; Danneskiold-Samsøe, Bente ; Bliddal, Henning ; Dreyer, Lene ; Locht, Henning ; Amris, Kirstine. / The course of pain hypersensitivity according to painDETECT in patients with rheumatoid arthritis initiating treatment : results from the prospective FRAME-cohort study. In: Arthritis Research & Therapy. 2018 ; Vol. 20.
@article{9a5088ac3b224068b63e0b61cb6bd1fa,
title = "The course of pain hypersensitivity according to painDETECT in patients with rheumatoid arthritis initiating treatment: results from the prospective FRAME-cohort study",
abstract = "BACKGROUND: Evidence is emerging that pain in rheumatoid arthritis (RA) exists without underlying inflammation. Our objective was to evaluate the prognostic value of pain classification at treatment initiation using the painDETECT questionnaire (PDQ). Outcomes were change in DAS28-CRP and RAMRIS synovitis score.METHODS: RA patients initiating a disease-modifying anti-rheumatic drug (DMARD) or initiating/ switching a biological agent were included. Follow-up time was 4 months. Clinical examination, imaging (MRI, dynamic contrast-enhanced MRI (DCE-MRI)), and patient-reported outcomes were undertaken. The PDQ was used to differentiate pain mechanisms. Mean change (95{\%} CI) was calculated using ANCOVA. Multivariable regression models were used to determine a prognostic value.RESULTS: A total of 102 patients were included; 75 were enrolled for MRI. Mean changes in baseline variables were greatest in the high PDQ classification group (> 18), while limited in the intermediate group (13-18). The 12 patients with high baseline PDQ score all changed pain classification group. No prognostic value of PDQ pain classification was found in relation to change of DAS28-CRP, RAMRIS score, or VAS pain. In the unadjusted model, RAMRIS score at baseline was associated with change in DAS28-CRP. The exploratory variables of DCE-MRI did not differ from other inflammatory variables.CONCLUSIONS: In RA patients a high PDQ score (non-nociceptive pain) at baseline was not associated with worse outcomes, in fact these patients had numerically greater improvement in DAS28-CRP. However, pain classification by PDQ was not independently associated with change in DAS28-CRP, RAMRIS score, or VAS pain in the prognostic models. Furthermore, patients classified with a high baseline PDQ score changed pain classification group. Patients with unclear pain mechanism had reduced numerically treatment response.TRIAL REGISTRATION: The study was approved by the Regional Ethics Committee of the Capital of Denmark April 18 2013; identification number H-3-2013-049 .",
keywords = "Central sensitization, Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), PainDETECT questionnaire, Prognostics, Rheumatoid arthritis",
author = "Signe Rifbjerg-Madsen and Christensen, {Anton Wulf} and Mikael Boesen and Robin Christensen and Bente Danneskiold-Sams{\o}e and Henning Bliddal and Lene Dreyer and Henning Locht and Kirstine Amris",
year = "2018",
month = "5",
day = "30",
doi = "10.1186/s13075-018-1581-4",
language = "English",
volume = "20",
journal = "Arthritis Research & Therapy",
issn = "1478-6354",
publisher = "BioMed Central",

}

The course of pain hypersensitivity according to painDETECT in patients with rheumatoid arthritis initiating treatment : results from the prospective FRAME-cohort study. / Rifbjerg-Madsen, Signe; Christensen, Anton Wulf; Boesen, Mikael; Christensen, Robin; Danneskiold-Samsøe, Bente; Bliddal, Henning; Dreyer, Lene; Locht, Henning; Amris, Kirstine.

In: Arthritis Research & Therapy, Vol. 20, 105, 30.05.2018.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - The course of pain hypersensitivity according to painDETECT in patients with rheumatoid arthritis initiating treatment

T2 - results from the prospective FRAME-cohort study

AU - Rifbjerg-Madsen, Signe

AU - Christensen, Anton Wulf

AU - Boesen, Mikael

AU - Christensen, Robin

AU - Danneskiold-Samsøe, Bente

AU - Bliddal, Henning

AU - Dreyer, Lene

AU - Locht, Henning

AU - Amris, Kirstine

PY - 2018/5/30

Y1 - 2018/5/30

N2 - BACKGROUND: Evidence is emerging that pain in rheumatoid arthritis (RA) exists without underlying inflammation. Our objective was to evaluate the prognostic value of pain classification at treatment initiation using the painDETECT questionnaire (PDQ). Outcomes were change in DAS28-CRP and RAMRIS synovitis score.METHODS: RA patients initiating a disease-modifying anti-rheumatic drug (DMARD) or initiating/ switching a biological agent were included. Follow-up time was 4 months. Clinical examination, imaging (MRI, dynamic contrast-enhanced MRI (DCE-MRI)), and patient-reported outcomes were undertaken. The PDQ was used to differentiate pain mechanisms. Mean change (95% CI) was calculated using ANCOVA. Multivariable regression models were used to determine a prognostic value.RESULTS: A total of 102 patients were included; 75 were enrolled for MRI. Mean changes in baseline variables were greatest in the high PDQ classification group (> 18), while limited in the intermediate group (13-18). The 12 patients with high baseline PDQ score all changed pain classification group. No prognostic value of PDQ pain classification was found in relation to change of DAS28-CRP, RAMRIS score, or VAS pain. In the unadjusted model, RAMRIS score at baseline was associated with change in DAS28-CRP. The exploratory variables of DCE-MRI did not differ from other inflammatory variables.CONCLUSIONS: In RA patients a high PDQ score (non-nociceptive pain) at baseline was not associated with worse outcomes, in fact these patients had numerically greater improvement in DAS28-CRP. However, pain classification by PDQ was not independently associated with change in DAS28-CRP, RAMRIS score, or VAS pain in the prognostic models. Furthermore, patients classified with a high baseline PDQ score changed pain classification group. Patients with unclear pain mechanism had reduced numerically treatment response.TRIAL REGISTRATION: The study was approved by the Regional Ethics Committee of the Capital of Denmark April 18 2013; identification number H-3-2013-049 .

AB - BACKGROUND: Evidence is emerging that pain in rheumatoid arthritis (RA) exists without underlying inflammation. Our objective was to evaluate the prognostic value of pain classification at treatment initiation using the painDETECT questionnaire (PDQ). Outcomes were change in DAS28-CRP and RAMRIS synovitis score.METHODS: RA patients initiating a disease-modifying anti-rheumatic drug (DMARD) or initiating/ switching a biological agent were included. Follow-up time was 4 months. Clinical examination, imaging (MRI, dynamic contrast-enhanced MRI (DCE-MRI)), and patient-reported outcomes were undertaken. The PDQ was used to differentiate pain mechanisms. Mean change (95% CI) was calculated using ANCOVA. Multivariable regression models were used to determine a prognostic value.RESULTS: A total of 102 patients were included; 75 were enrolled for MRI. Mean changes in baseline variables were greatest in the high PDQ classification group (> 18), while limited in the intermediate group (13-18). The 12 patients with high baseline PDQ score all changed pain classification group. No prognostic value of PDQ pain classification was found in relation to change of DAS28-CRP, RAMRIS score, or VAS pain. In the unadjusted model, RAMRIS score at baseline was associated with change in DAS28-CRP. The exploratory variables of DCE-MRI did not differ from other inflammatory variables.CONCLUSIONS: In RA patients a high PDQ score (non-nociceptive pain) at baseline was not associated with worse outcomes, in fact these patients had numerically greater improvement in DAS28-CRP. However, pain classification by PDQ was not independently associated with change in DAS28-CRP, RAMRIS score, or VAS pain in the prognostic models. Furthermore, patients classified with a high baseline PDQ score changed pain classification group. Patients with unclear pain mechanism had reduced numerically treatment response.TRIAL REGISTRATION: The study was approved by the Regional Ethics Committee of the Capital of Denmark April 18 2013; identification number H-3-2013-049 .

KW - Central sensitization

KW - Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)

KW - PainDETECT questionnaire

KW - Prognostics

KW - Rheumatoid arthritis

U2 - 10.1186/s13075-018-1581-4

DO - 10.1186/s13075-018-1581-4

M3 - Journal article

C2 - 29848348

VL - 20

JO - Arthritis Research & Therapy

JF - Arthritis Research & Therapy

SN - 1478-6354

M1 - 105

ER -