FRI0076 Chronic widespread pain in patients with rheumatoid arthritis: a seven year follow-up of pain distribution and factors for improvement
Authors: M.L. Andersson, B. Svensson, S. Bergman
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The knowledge of chronic widespread pain and factors associated to improvement of pain in patients with RA is sparse, in particular regarding longitudinal studies. <h3>Objectives</h3> To describe the change of pain distribution reports over time and to identify factors that predict improvement from chronic widespread pain in patients with RA. <h3>Methods</h3> Two postal questionnaires were sent out to patients included in the BARFOT (Better anti-rheumatic pharmacotherapy) study, the first in 2010 and the second in 2017. The questionnaire included a pain mannequin, NRS scales of pain, patient global assessment (PatGA) and fatigue, health assessment questionnaire (HAQ), health related quality of life measured by EQ-5D and patient reported BMI and 28-joint count of tender (TJC) and swollen joints (SJC). The responders to both questionnaires were divided into 3 groups according to the reported pain duration and distribution at each time point— patients having no chronic pain (NCP), chronic widespread pain (CWP), and chronic regional pain (CRP). <h3>Results</h3> 1525 (73%) patients answered the pain questions in 2010 and 1046 (68%) in 2017. In all 950 of the patients answered the questions at both time points and were included in the study. One third (324) of the patients had reported ,<sup>CWP in 2010</sup><sup>and</sup> 140 (43%) of the patients with CWP in 2010 had improved in 2017. The patients, who improved, had lower BMI, p=0.045, less tender joint counts, p=0.007, less pain, p=0.005, less fatigue, p&lt;0.001 and less painful regions, p&lt;0.001, better PatGA, p=0.002, better HAQ, p&lt;0.001 and better EQ-5D, p=0.003. Fifty-five percent of the patients who improved were treated with DMARD, compared to 52% of those not improving, the rate treated with biologics were 32% vs. 26%. There were, however, no statistical significant difference in medical treatment between the groups, p=0.088. Age and sex adjusted logistic regression models showed an increased chance for improvement from CWP in patients with normal BMI, less TJC, pain, fatigue and tender regions and better PatGA, HAQ and EQ-5D, table 1. Biologic treatment also increased the chances to improve from CWP. The most common biologic treatment was anti-TNF treatment. Of the patients, who were treated with biologics, 86% in the group, who improved from CWP and 74% in the group, who did not improve, were treated with anti-TNF treatment. Age, gender, smoking habits, SJC and glucocorticoid treatment were not associated with improvement in the model. <h3>Conclusions</h3> Lower scores in pain related variables and fatigue, normal BMI, better physical function and health-related quality of life, and biologic treatment were associated to improvement from CWP in patients with RA. Knowledge of factors associated to improvement from CWP could be helpful when treating RA patients with CWP. More studies with focus on improvement from chronic pain in patients with RA are needed. <h3>Disclosure of Interest</h3> None declared