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High prevalence of widespread pain in women with early rheumatoid arthritis

Journal article
Authors Annelie Bilberg
Tomas Bremell
Jan Bjersing
Kaisa Mannerkorpi
Published in Scandinavian Journal of Rheumatology
Volume 47
Issue 6
Pages 447-454
ISSN 0300-9742
Publication year 2018
Published at Institute of Neuroscience and Physiology, Department of Health and Rehabilitation
Institute of Medicine, Department of Rheumatology and Inflammation Research
Pages 447-454
Language en
Keywords health-assessment questionnaire, disease-activity score, grip force, activity limitation, construct-validity, physical-activity, hospital, anxiety, muscle strength, 28 joints, fibromyalgia
Subject categories Rheumatology and Autoimmunity


Objectives: The aim of the study was to determine the prevalence of widespread pain (WP) in women with early rheumatoid arthritis (RA) and to compare physical function, activity limitations, health-related quality of life, mental distress, and disease activity between women with WP and non-widespread pain (NWP). Method: This cross-sectional study included 102 women with early RA. Participants were provided with self-reported questionnaires quantifying activity limitations, physical activity, pain intensity, health-related quality of life, and fatigue. Hand-grip force, muscle function test of the lower extremities, erythrocyte sedimentation rate, and number of tender and swollen joints were assessed. Results: One-third (35.9%) of the women fulfilled the American College of Rheumatology criteria for WP 20 months after disease onset. Women with RA + WP had significantly higher 28-joint Disease Activity Score (DAS28) (p = 0.004), number of tender joints (p = 0.001), pain intensity (p < 0.001), fatigue (p < 0.001), Health Assessment Questionnaire score (p < 0.001), and Hospital Anxiety and Depression Scale - Depression (p = 0.001). Furthermore, women with RA + WP showed significantly worse global health (p < 0.001) and physical health (36-item Short Form Health Survey - Physical Component Summary) (p < 0.001). The hand-grip force was found to be significantly reduced (p = 0.001), as was the muscle function of the lower extremities (p < 0.001), for women with RA + WP compared to women with RA + NWP. After adjustment for inflammatory joint disease, the significant differences between the groups remained. Conclusion: A significant group of women with early RA experience WP with a high DAS28 and increased pain intensity level. These women display severe muscle function deficiency in clinical examinations, and report general activity limitations and low psychological and physical health, despite an absence of or low objective signs of inflammation.

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