AB0955 FEATURES OF THE PAIN SYNDROME IN RHEUMATOID ARTHRITIS (RA)
Authors: S. Lezhenina, N. Shuvalova, A. Lammert, E. Guryanova
Journal: Annals of the Rheumatic Diseases (2020)

Background: The neuropathic component is present in the mechanism of pain in RA in 36% of cases. The presence of anxiety-depressive disorders and a decrease in the quality of life in patients with RA are shown. Objectives: The study of the clinical features of pain in RA in men and women. Methods: The group consisted of 134 patients with RA (94 women and 40 men), aged 36 to 60 years (average age 48.6 ± 7.1 years) and disease duration from 1 year to 10 years (4.03 ± 1.6 years) hospitalized in the rheumatology department of the Republican Clinical Hospital (Cheboksary). At the time of inclusion in the study, all patients were in the active stage of the disease. An assessment of rheumatological and neurological status was carried out. Pain assessment was performed using: Visual Analog Scale (VAS); Ritchie articular index (RAI). The severity of neuropathic pain was determined using the diagnostic neuropathic pain questionnaire DN4 and PainDetect (sensitivity - 82.9%; specificity - 89.9%). To determine the psycho-emotional deviations used: general health questionnaire (anxiety and depression) - General Health Questionnaire (form GHQ – 28); HADS; Spilberger-Hanin situational and personal anxiety scale. Patient mobility limitations were assessed using the Rivermead mobility index score scale, and quality of life was quantified using the EQ-5D visual analogue scale. To assess the activity of the disease, the level of C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), and the DAS index - 28-CRP were used. To assess mental and physical functioning, a standardized questionnaire The Short Form-36 was used. To visualize the stage, survey radiographs were used in the direct projection of the metacarpophalangeal and metatarsophalangeal joints, wrist joints, proximal interphalangeal joints of the hands; distal parts of the feet. Results: An analysis of chronic pain syndrome in 36% of patients revealed a neuropathic component of pain (DN4: 5.7 ± 1.1 points, PainDetect: 16.3 ± 4.2). In the group of patients with neuropathic pain (n = 78) aged 55.1 ± 7.9 years, the duration of the disease was 3.4 ± 0.9 years, the more advanced and late clinical stages of the disease, III – IV radiological stages of RA were more common, were present neurological disorders and complaints characteristic of peripheral polyneuropathy. Rivermead mobility index in patients with neuropathic disorders, (n = 78) was 9.1 ± 0.8 points, in the absence of neuropathic disorders (n = 56), 11.2 ± 1.1 points. There were no significant differences in process activity (DAS index - 28 - CRP) and quality of life. According to the questionnaire of situational and personal anxiety, Spilberger-Khanin revealed moderate anxiety and mild - depressive disorders. Quality of life was reduced in all patients with RA. Pain syndrome in patients with neuropathic pain with symptomatic (NSAIDs, GC) and basic cytostatic therapy (methotrexate) showed that, despite the decrease in the severity of the inflammatory process, the positive dynamics was partial (VAS before therapy 6.4 ± 0, 7; VAS in the presence of therapy 4.3 ± 0.5 (p&gt; 0.05); PainDetect = 14.9 ± 4.4; DN4 = 4.3 ± 1.5). In men, statistically significant factors associated with pain were clinical parameters that accounted for 37% and 18% of pain variation (Ritchie articular index (CIR): Fsmc = 4.107, p &lt;0.001; SF-36: Fsmc = 2.107, p &lt;0.001) In women, the main significant factors associated with pain were the subjective feeling of pain and psychological characteristics that accounted for 12% of the pain variation (SF-36: Fsmc = 11.118, p &lt;0.001). Conclusion: A dynamic study of patients with RA in accordance with gender and age will further develop additional criteria for evaluating the effectiveness of complex therapy used to treat chronic pain, and will also increase the overall effectiveness of treatment. Disclosure of Interests: None declared