Division of Internal Medicine, Hospital Central Sur de Pemex, Mexico City, Mexico.
Division of Rheumatology, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden.
Clin Rheumatol. 2019 Oct;38(10):2709-2716. doi: 10.1007/s10067-019-04574-6. Epub 2019 May 10.
Pain is a core complaint among rheumatoid arthritis (RA) patients, and persistent pain requires treatment adjustments according to current strategies. We aimed to quantify the impact of hand osteoarthritis (OA) on health status and residual pain in patients with RA.
This cross-sectional survey compared RA patients with and without osteoarthritis of the hand. The main outcome was pain intensity. Other measurements included disease activity scores (the Disease Activity Score 28-joints; the Simplified Disease Activity Index, SDAI; the Clinical Disease Activity Index, CDAI), functional disability and self-reported quality of life, and the proportion of patients with residual pain (Patient Acceptable Symptom State, PASS).
Eighty-one patients were analyzed, including 39 with RA and OA and 42 with RA only. The patients were mainly women (94%), with a median disease duration of 13 years. This group also reported a higher intensity of pain (visual analogue scale, VAS 70 mm vs. 30 mm; p = 0.003), higher disease activity (3.89 vs. 2.88; p = 0.001), and greater functional disability irrespective of treatment and comorbidities. A strong correlation (r = 0.69; p < 0.001) between pain and disease activity was observed, although no differences in pain were observed between groups according to disease activity categories. Patients with RA and OA had a higher proportion of residual pain (59% vs. 29%; p = 0.006) even in the absence of clinical inflammation.
The coexistence of RA and hand OA is associated with distorted disease activity measurements in RA. Osteoarthritis contributes to persistent pain and greater disability in patients with RA.
疼痛是类风湿关节炎（RA）患者的核心主诉，持续性疼痛需要根据当前策略进行治疗调整。我们旨在量化手骨关节炎（OA）对手部 RA 患者健康状况和残余疼痛的影响。
本横断面研究比较了手部有和没有 OA 的 RA 患者。主要结局是疼痛强度。其他测量指标包括疾病活动评分（28 关节疾病活动评分；简化疾病活动指数，SDAI；临床疾病活动指数，CDAI）、功能障碍和自我报告的生活质量，以及有残余疼痛的患者比例（患者可接受的症状状态，PASS）。
共分析了 81 名患者，其中 39 名患有 RA 和 OA，42 名仅患有 RA。患者主要为女性（94%），中位病程 13 年。该组报告的疼痛强度更高（视觉模拟评分，70mm 比 30mm；p=0.003），疾病活动度更高（3.89 比 2.88；p=0.001），且无论治疗和合并症如何，功能障碍更大。疼痛与疾病活动度之间存在很强的相关性（r=0.69；p<0.001），但根据疾病活动度类别，两组之间的疼痛无差异。即使没有临床炎症，患有 RA 和 OA 的患者也有更高比例的残余疼痛（59%比 29%；p=0.006）。
RA 和手部 OA 的共存会导致 RA 中疾病活动度测量的扭曲。OA 会导致 RA 患者持续疼痛和更大的残疾。
