两种类风湿关节炎队列中不同标准下慢性广泛性疼痛患病率的比较。
Comparison of chronic widespread pain prevalence with different criteria in two cohorts of rheumatoid arthritis.
机构信息
Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Spenshult Research and Development Center, Halmstad, Sweden.
出版信息
Clin Rheumatol. 2022 Apr;41(4):1023-1032. doi: 10.1007/s10067-021-05999-8. Epub 2021 Nov 23.
OBJECTIVE
This study aims to investigate chronic widespread pain with the 1990 (CWP1990) and 2019 (CWP2019) definitions 6 years after the onset of rheumatoid arthritis (RA), in one patient cohort with tight controls and one conventional cohort, and factors associated with reporting CWP1990 and CWP2019, respectively.
METHODS
A cohort of 80 RA patients with monthly visits to the physician the first 6 months was compared to a cohort of 101 patients from the same clinic with conventional follow-up. Both cohorts had early RA (< 13 months). The prevalence of CWP1990 and the more stringent CWP2019 were in a 6-year follow-up investigated with a questionnaire, including a pain mannequin and a fear-avoidance beliefs questionnaire.
RESULTS
In the tight control cohort, 10% reported CWP2019 after 6 years compared to 23% in the conventional cohort (p = 0.026). There was no difference when using the CWP1990 definition (27% vs 31%, p = 0.546). When adjusted for important baseline data, the odds ratio for having CWP2019 was 2.57 (95% CI 1.02-6.50), in the conventional group compared to the tight control group (p = 0.046). A high level of fear-avoidance behaviour towards physical activity was associated with CWP2019, OR 10.66 (95% CI 1.01-112.14), but not with CWP1990 in the tight control cohort.
CONCLUSION
A more stringent definition of CWP identifies patients with a more serious pain condition, which potentially could be prevented by an initial tight control management. Besides tight control, caregivers should pay attention to fear-avoidance behaviour and tailor treatment.
KEY POINTS
• CWP2019 is a more stringent definition of chronic widespread pain and identifies patients with a more serious pain condition. • Patients with a serious pain condition could be helped by frequent follow-ups. • This study suggests that a special attention of fear-avoidance behaviour towards physical activity in patients with RA is needed.
目的
本研究旨在探讨类风湿关节炎（RA）发病 6 年后，使用 1990 年（CWP1990）和 2019 年（CWP2019）定义，在一个严格控制的患者队列和一个常规队列中，慢性广泛性疼痛的情况，以及与分别报告 CWP1990 和 CWP2019 相关的因素。
方法
将每月到医生处就诊的 80 例 RA 患者队列与来自同一诊所的 101 例常规随访患者队列进行比较。两个队列的 RA 均处于早期（<13 个月）。使用问卷（包括疼痛模型和恐惧回避信念问卷）在 6 年随访中调查 CWP1990 和更严格的 CWP2019 的患病率。
结果
在严格控制组中，6 年后有 10%的患者报告 CWP2019，而常规组中这一比例为 23%（p=0.026）。当使用 CWP1990 定义时，差异无统计学意义（27%比 31%，p=0.546）。当调整重要的基线数据后，与严格控制组相比，常规组发生 CWP2019 的比值比为 2.57（95%CI 1.02-6.50）（p=0.046）。对体力活动的高度恐惧回避行为与 CWP2019 相关，OR 为 10.66（95%CI 1.01-112.14），但在严格控制组中与 CWP1990 无关。
结论
更严格的 CWP 定义可以识别出疼痛状况更严重的患者，通过初始严格控制管理可能预防这种情况。除了严格控制外，护理人员还应注意恐惧回避行为，并进行个体化治疗。
关键点
CWP2019 是慢性广泛性疼痛的更严格定义，可以识别出疼痛状况更严重的患者。
病情严重的患者可以通过频繁随访得到帮助。
本研究表明，RA 患者的体力活动恐惧回避行为需要特别关注。
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