Spondyloarthritis & psoriatic arthritis
Persistent pain and its predictors after starting anti-tumour necrosis factor therapy in psoriatic arthritis: what is the role of inflammation control?
Authors' conclusion
A substantial proportion of PsA patients reported unacceptable pain throughout the first anti-TNF treatment year. At 12 months, refractory pain constituted about two-thirds of this remaining pain load. More objective signs of inflammation at anti-TNF initiation were associated with less future refractory pain.
Study context
- Population
- Bionaïve psoriatic arthritis (PsA) patients starting a first anti-tumour necrosis factor (anti-TNF) therapy 2004–2010, South Swedish Arthritis Treatment Group register
- Participants
- 351 patients
- Outcome
- Unacceptable pain (VAS pain > 40 mm) and refractory pain (VAS pain > 40 mm + CRP < 10 mg/L + ≤ 1 swollen joint of 28)
- Follow-up
- 0, 3, 6, and 12 months
Methodological detailslogistic regression
- Logistic regression
Main finding
As reported in the abstract
Unacceptable pain upon starting anti-TNF
85%
Unacceptable pain at 3 months, then remaining stable
43%
Refractory pain as proportion of all unacceptable pain at 12 months
63%
Observational data: associations, not effects.
Further findings
Baseline predictors of 12-month unacceptable/refractory pain
- Higher baseline visual analogue scale (VAS) pain/global, worse physical function and lower health-related quality-of-life associated with higher risk of unacceptable/refractory pain
- More swollen joints and higher evaluator's global assessment associated with lower risk of refractory pain
Original publication
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