OP0064 CHARACTERIZING PREVALENT NON-ARTICULAR PAIN AT EARLY RA DIAGNOSIS AND EVOLUTION OVER THE FIRST YEAR OF RA TREATMENT: RESULTS FROM THE CANADIAN EARLY ARTHRITIS COHORT STUDY
Authors: C. Meng, Y. Lee, O. Schieir, M. F. Valois, M. Butler, G. Boire, G. Hazlewood, C. A. Hitchon, E. Keystone, D. Tin, C. Thorne, L. Bessette, J. Pope, S. J. Bartlett, V. Bykerk
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> For RA patients, having their pain addressed is important, whether the pain is inside the joint or outside of it. Active RA may lead to non-articular pain (NAP) through a cycle of inactivity, deconditioning and soft tissue injury. NAP is common in patients with early RA, regional vs widespread, and associated with lower remission rates[1]. It may require different management approaches. The frequency of different patterns of NAP at RA diagnosis and over time has not been described and the relationship between active RA joint inflammation and NAP is not well understood. Understanding of the common phenotypes of regional NAP and the role of RA-related joint inflammation could help better personalize RA care. <h3>Objectives:</h3> To describe common NAP presentations around the time of early RA diagnosis, evolution over the first year of early RA treatment, and associations with corresponding active RA inflammation. <h3>Methods:</h3> Data were from patients with active early RA (symptoms&lt;1 year, CDAI&gt;2.8) diagnosed by a rheumatologist enrolled in the Canadian Early Arthritis Cohort (CATCH) between Jan/2017-Feb/2022. Rheumatologists performed systematic clinical assessments including joint counts, and patients were given explicit instructions to indicate any non-joint pain they experienced on a Margolis body pain diagram (BPD) at baseline (BL), and 6- and/or 12-month follow up visits. Prespecified NAP patterns were classified based on pain reported in 5 sections (4 quadrants and axial[1,2], excluding hands and feet) and grouped as: 1) no NAP (no sections selected on BPD), 2) regional (1-2 sections) or 3) widespread NAP(3+sections). Descriptive statistics were used to summarize the frequency and evolution of different NAP patterns at baseline and over the 12-months of follow-up and compared the proportions of tender and/or swollen large proximal joints (shoulders, elbows, hips, knees) by presence of corresponding pain in each NAP section reported on the BPD using Chi-square and Fisher exact tests. <h3>Results:</h3> The study sample included 392 early RA patients; 70% were female, mean(sd) age was 56(14); 75% were seropositive, mean symptoms duration 5.1(2.7) months, mean(sd) CDAI 26.6(13.4) and 79% were treated with a MTX-inclusive regimen. Over half of patients reported prevalent NAP at baseline (n=201, 51%), of which nearly 3 in 4 presented with regional NAP (146 (73%)). The most frequent patterns of regional NAP were axial (34%), pain in both upper quadrants (20%) and both lower quadrants (10%), respectively. Of those with prevalent regional NAP, it persisted or worsened in 42% over one year (Table 1). Of those with prevalent widespread NAP, 73% resolved or improved to regional NAP. Joint inflammation tended to be more frequently reported in corresponding locations with NAP vs without NAP, and often persisted over follow-up (Table 2). <h3>Conclusion:</h3> NAP, particularly regional NAP, is common in early RA throughout their first year of diagnosis. Common patterns of regional NAP include axial, both upper quadrants and both lower quadrants. The significantly higher frequency of tender and/or swollen joints within most areas of NAP over time provides preliminary data to suggest RA activity may contribute to NAP. More studies are needed and early intervention to prevent and treat NAP in patients with RA is recommended. <h3>REFERENCES:</h3> [1] Bykerk VP, Schieir O, Valois MF. Regional and widespread patterns of non-articular pain are common at RA diagnosis and contribute to poor outcomes at 12 months. Ann Rheum Dis 2020;79: Supp 1:585. [2] Schelin M, Westerlind H, Lindqvist J, et al. Widespread non-joint pain in early rheumatoid arthritis. Scand J Rheumatol 2021;50:271-9. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Charis Meng: None declared, Yvonne Lee Pfizer Aspire Grant, payment to medical writer on authors' behalf for Eli Lilly, Sanofi Genzyme, Orit Schieir: None declared, Marie-France Valois: None declared, Margaret Butler: None declared, Gilles Boire Abbvie, Bms, Orimed Pharma, Viatris, Abbvie, BMS, Gilead, Janssen, Lilly, Mylan, Novartis, Pfizer, Samsung Biopepis, Sanofi, Teva, Viatris, BMS, Eli Lilly, Janssen, Merck, Pfizer, Glen Hazlewood: None declared, Carol A Hitchon Pfizer, UCB, Public Health Agency of Canada, Research Manitoba, Health Sciences Centre Foundation, Edward Keystone Abbvie, Amgen, Celltrion, Myriad Autoimmune, F. Hoffman-LaRoche, Janssen, Lilly Pharmaceuticals, Merck, Pfizer, Sandoz, Sanofi-Genzyme, Samsung Biopepsis, Abbvie, Amgen, Celltrion, Myriad Autoimmune, F. Hoffman-LaRoche Inc, Janssen Inc, Lilly, Merck Pfizer, Sandoz, Sanofi-Genzyme,. Samsung Bioepsis, Amgen, Merck, Pfizer, Diane Tin: None declared, Carter Thorne Medexus/Medac, Abbvie, Centocor, Janssen, Medexus, Novartis, Pfizer, Sandoz, Sanofi, Pfizer, Louis Bessette Amgen, BMS, Janssen, UCB, Abbvie, Pfizer, Merck, Sanofi, Lilly, Novartis, TEVA, Fresenius Kabi Sandoz, Organon, Abbvie, BMS, Gilead, Janssen, Lilly, Mylan, Novartis, Pfizer, Samsung Bioepis, Sanofi, Teva, Viatris, Amgen, BMS, Janssen, Roche, UCB Abbvie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilead, Janet Pope UCB, AbbVie, Actelion, Amgen, Bayer, BMS, Eicos Sciences, Eli Lilly, Emerald, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Abbvie, BMS, Eli Lilly, Merck, Roche, Seattle Genetics, UCB, Susan J. Bartlett Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Vivian Bykerk BMS, Janssen, Pfizer.