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Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate

OBJECTIVE: To investigate the frequency of remaining pain in early rheumatoid arthritis (RA) after 3 months of treatment with methotrexate as the only disease modifying antirheumatic drug, with a special focus on patients with a good clinical response. METHODS: The study base was cases reported to a...

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Autores principales: Altawil, Reem, Saevarsdottir, Saedis, Wedrén, Sara, Alfredsson, Lars, Klareskog, Lars, Lampa, Jon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129578/
https://www.ncbi.nlm.nih.gov/pubmed/26784398
http://dx.doi.org/10.1002/acr.22790
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author Altawil, Reem
Saevarsdottir, Saedis
Wedrén, Sara
Alfredsson, Lars
Klareskog, Lars
Lampa, Jon
author_facet Altawil, Reem
Saevarsdottir, Saedis
Wedrén, Sara
Alfredsson, Lars
Klareskog, Lars
Lampa, Jon
author_sort Altawil, Reem
collection PubMed
description OBJECTIVE: To investigate the frequency of remaining pain in early rheumatoid arthritis (RA) after 3 months of treatment with methotrexate as the only disease modifying antirheumatic drug, with a special focus on patients with a good clinical response. METHODS: The study base was cases reported to a population‐based early RA cohort who had followup data from the Swedish Rheumatology Quality Register (n = 1,241). The Disease Activity Score in 28 joints European League Against Rheumatism (EULAR) response criteria were used to evaluate clinical response to treatment as good, moderate, and no response. The primary end point was remaining pain at the 3‐months followup visit, defined as pain >20 mm on a 100‐mm visual analog scale (VAS). RESULTS: Remaining pain in spite of a EULAR good response at followup was associated with higher baseline disability, using the Health Assessment Questionnaire (adjusted odds ratio [OR] 2.2 [95% confidence interval (95% CI) 1.4–3.4] per unit increase), and less baseline inflammation, using the erythrocyte sedimentation rate (adjusted OR 0.81 [95% CI 0.70–0.93] per 10‐mm increase). Similar associations were detected for remaining pain at followup in spite of low inflammatory activity, defined as a C‐reactive protein level <10. Increase in VAS pain during the treatment period was observed in 19% of the whole cohort, with frequencies in the EULAR response groups of 9% (good response), 15% (moderate response), and 45% (no response). CONCLUSION: These results are in line with the hypothesis that a subgroup of early RA patients exhibits pain that is not inflammatory mediated, where alternative treatment strategies to traditional antiinflammatory medications need to be considered.
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spelling pubmed-51295782016-12-02 Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate Altawil, Reem Saevarsdottir, Saedis Wedrén, Sara Alfredsson, Lars Klareskog, Lars Lampa, Jon Arthritis Care Res (Hoboken) Rheumatoid Arthritis OBJECTIVE: To investigate the frequency of remaining pain in early rheumatoid arthritis (RA) after 3 months of treatment with methotrexate as the only disease modifying antirheumatic drug, with a special focus on patients with a good clinical response. METHODS: The study base was cases reported to a population‐based early RA cohort who had followup data from the Swedish Rheumatology Quality Register (n = 1,241). The Disease Activity Score in 28 joints European League Against Rheumatism (EULAR) response criteria were used to evaluate clinical response to treatment as good, moderate, and no response. The primary end point was remaining pain at the 3‐months followup visit, defined as pain >20 mm on a 100‐mm visual analog scale (VAS). RESULTS: Remaining pain in spite of a EULAR good response at followup was associated with higher baseline disability, using the Health Assessment Questionnaire (adjusted odds ratio [OR] 2.2 [95% confidence interval (95% CI) 1.4–3.4] per unit increase), and less baseline inflammation, using the erythrocyte sedimentation rate (adjusted OR 0.81 [95% CI 0.70–0.93] per 10‐mm increase). Similar associations were detected for remaining pain at followup in spite of low inflammatory activity, defined as a C‐reactive protein level <10. Increase in VAS pain during the treatment period was observed in 19% of the whole cohort, with frequencies in the EULAR response groups of 9% (good response), 15% (moderate response), and 45% (no response). CONCLUSION: These results are in line with the hypothesis that a subgroup of early RA patients exhibits pain that is not inflammatory mediated, where alternative treatment strategies to traditional antiinflammatory medications need to be considered. John Wiley and Sons Inc. 2016-07-22 2016-08 /pmc/articles/PMC5129578/ /pubmed/26784398 http://dx.doi.org/10.1002/acr.22790 Text en © 2016 The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Rheumatoid Arthritis
Altawil, Reem
Saevarsdottir, Saedis
Wedrén, Sara
Alfredsson, Lars
Klareskog, Lars
Lampa, Jon
Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate
title Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate
title_full Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate
title_fullStr Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate
title_full_unstemmed Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate
title_short Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate
title_sort remaining pain in early rheumatoid arthritis patients treated with methotrexate
topic Rheumatoid Arthritis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129578/
https://www.ncbi.nlm.nih.gov/pubmed/26784398
http://dx.doi.org/10.1002/acr.22790
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