Baseline predictors of unacceptable pain (VAS pain >40 mm), overall and in patients with low inflammation (CRP <10 mg/L), plus predictors of pain over time from diagnosis to 2 years, in 10,297 patients with early RA (symptom duration <12 months) newly diagnosed in Sweden between 2012–2020.
At 2-year follow-up (n=3,427), 33% had unacceptable pain and 26% had unacceptable pain despite low inflammation. In multivariable analysis, female sex, higher baseline VAS pain, tender-swollen joint difference ≥7, and lower ESR were the strongest predictors of unacceptable pain at 1 and 2 years. Smoking, non-European origin, and psychiatric or pain-related comorbidities were independently linked to more pain over time.
- Observational design with substantial missing follow-up data (~27% with 2-year VAS pain data out of 10,297), risking selection toward more severe cases. - Pain medication data unavailable, so analgesic use could not be accounted for. - Serological status (ACPA/RF) derived from ICD-10 codes rather than lab values, introducing potential misclassification.
At RA diagnosis, screen for a tender-swollen joint difference ≥7, high patient-reported outcomes (fatigue, global assessment, HAQ), and low inflammatory markers — these flag patients at highest risk of persistent, non-inflammatory pain who may need early multimodal pain management. Also factor in sex, birth origin, smoking, and psychiatric or pain comorbidities when planning individualized follow-up.
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