Further evaluation of inflammatory and non-inflammatory aspects of pain in rheumatoid arthritis patients

Objective: A high discrepancy between the number of tender and swollen joints (e.g. DTSJ ≥ 7) has previously been used as an indication for the presence of changes in central mechanisms in patients with moderate-to-high disease activity. In this study, we explored whether the DTSJ can also be used to obtain insights into the underlying pain mechanisms in patients with on average well-controlled disease activity. 

Methods: A 2 year retrospective analysis of routinely obtained 28-joint DAS (DAS28) components was performed on 45 patients with low inflammatory activity at the group level. All patients underwent pressure pain threshold (PPT) and electrical pain threshold (EPT) measurements and completed four self-report questionnaires [short-form 36 (SF-36v2); central sensitization inventory (CSI); generalized pain questionnaire (GPQ); and the pain catastrophizing scale (PCS)]. 

Results: Patients with a DTSJ ≥ 3 at least once in the past 2 years showed significantly lower EPT and PPT values and higher levels of pain and disability on the SF-36v2 compared with the DTSJ < 3 group. Furthermore, GPQ scores were significantly higher in those with DTSJ ≥ 3, while CSI and PCS scores were similar. 

Conclusion: These findings suggest that in patients in the DTSJ ≥ 3 group, mechanisms other than inflammation (only) underlie the pain. Moreover, our findings suggest that among the multiple potential underlying psychological mechanisms, pain catastrophizing (as measured by the PCS) and psychological hypervigilance (as measured by the CSI) do not play an important role. These findings could be useful in the clinical management of the patient. Depending on the dominant mechanism underlying the (persistent) pain, patients might respond differently to treatment.