Persistent pain and its predictors after starting anti-tumour necrosis factor therapy in psoriatic arthritis: what is the role of inflammation control?

Autor: Roseman C; Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden., Wallman JK; Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden., Jöud A; Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden., Schelin M; Department of Clinical Sciences Lund, Oncology, Lund University, Lund, Sweden.; Department of Research and Development, Skåne University Hospital, Lund, Sweden.; The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden., Einarsson JT; Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden., Lindqvist E; Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden., Lampa J; Karolinska Institute, Department of Medicine Solna, Rheumatology Unit, Center of Molecular Medicine (CMM), Stockholm, Sweden., Kapetanovic MC; Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden., Olofsson T; Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden.; Department of Clinical Sciences Lund, Oncology, Lund University, Lund, Sweden.
Jazyk: angličtina
Zdroj: Scandinavian journal of rheumatology [Scand J Rheumatol] 2024 Mar; Vol. 53 (2), pp. 94-103. Date of Electronic Publication: 2023 Nov 30.
DOI: 10.1080/03009742.2023.2258644
Abstrakt: Objective: While considerable focus has been placed on pain due to inflammation in psoriatic arthritis (PsA), less is reported on pain despite inflammation control. Here, we aimed to investigate the occurrence/predictors of persistent pain, including non-inflammatory components, after starting anti-tumour necrosis factor (anti-TNF) therapy.
Method: Bionaïve PsA patients starting a first anti-TNF therapy 2004-2010 were identified (South Swedish Arthritis Treatment Group register; N = 351). Outcomes included unacceptable pain [visual analogue scale (VAS) pain > 40 mm], and unacceptable pain despite inflammation control (refractory pain; VAS pain > 40 mm + C-reactive protein < 10 mg/L + ≤ 1 swollen joint of 28), assessed at 0, 3, 6, and 12 months. Baseline predictors were estimated by logistic regression.
Results: Upon starting anti-TNF therapy, 85% of patients reported unacceptable pain, falling to 43% at 3 months and then remaining stable. After 12 months, refractory pain constituted 63% of all unacceptable pain. Higher baseline VAS pain/global, worse physical function and lower health-related quality-of-life were associated with a higher risk of unacceptable/refractory pain at 12 months. More swollen joints and higher evaluator's global assessment were associated with a lower risk of 12-month refractory pain.
Conclusions: A substantial proportion of PsA patients reported unacceptable pain throughout the first anti-TNF treatment year. At 12 months, refractory pain constituted about two-thirds of this remaining pain load. More objective signs of inflammation at anti-TNF initiation were associated with less future refractory pain. This highlights insufficient effect of biologics in patients with inflammation-independent pain, warranting alternative treatments.
Databáze: MEDLINE
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