Correlation of the score for subjective pain with physical disability, clinical and radiographic scores in recent onset rheumatoid arthritis

BMC Musculoskeletal Disorders

Fabiola Atzeni²  Marco Cazzola²  Maurizio Turiel¹  Benedetta Panni²  Tania Fiorini¹  Piercarlo Sarzi-Puttini² 

[1] Istituto di Scienze Biomediche, Università di Milano, Italy;Rheumatology Unit, University Hospital L. Sacco, Milan, Italy

关键词: pain measurement;    pain;    Rheumatoid arthritis;   

Others  :  1166294
DOI  :  10.1186/1471-2474-3-18

 received in 2001-12-12, accepted in 2002-07-19,  发布年份 2002

【 摘 要 】

Background

To analyse the relationship between subjective pain score and other measures of clinical, radiographic and functional status; in particular Larsen radiographic scores and Health Assessment Questionnaire (HAQ); in patients with severe rheumatoid arthritis (RA) with a disease duration of less than 3 years.

Methods

In this cross sectional study of 105 patients with RA (76 women, 29 men: mean age 50.93; mean disease duration 15.86 months; 71% rheumatoid factor positive) subjective pain was assessed according to the Visual Analog Scale (VAS). Correlation coefficients between pain score and disease activity measures (patients' global assessment of disease by VAS, number of tender and swollen joints, morning stiffness, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] and titre of rheumatoid factor, radiographic evaluations (Larsen-Dale scores for radiographic damage of the small joints of the hands, wrist and feet), disability measures (health assessment questionnaire [HAQ]), and demographic variables were calculated; hierarchical regression analysis was done with subjective pain score as the dependent variable.

Results

The Spearman's correlation coefficient comparing subjective pain and HAQ was 0.421 (p < 0.001), between subjective pain and global assessment of disease and morning stiffness was 0.573 (p < 0.001) and 0.427 (p < 0.001) respectively, and between pain and number of tender and swollen joints 0.037 and 0.050 respectively (p > 0.05). In regression analysis, global assessment of disease by patients explained 32.8% of the variation in pain intensity score, morning stiffness 10.7%, CRP 4.0%, HAQ 3.8% and Larsen-Dale scores explained 2.1%; other variables were not significant in the model.

Conclusions

Pain scores of patients with early severe rheumatoid arthritis are correlated at higher levels with patients' global assessment of disease and with morning stiffness rather than with radiographic or other clinical variables such as number of tender and swollen joints.

【 授权许可】

   
2002 Sarzi-Puttini et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 参考文献 】

• [1]La Montagna G, Tirri R, Baruffo A, Preto B, Viaggi S: Clinical pattern of pain in rheumatoid arthritis. Clin Exp Rheum 1997, 15:481-485.
• [2]Kazis LE, Meenan RF, Anderson JJ: Pain in the rheumatic disease. Arthritis Rheum 1983, 26:1017-1022.
• [3]Bird HA, Dixon JS: The measurement of pain. Baillieres Clin Rheumatol 1987, 1:71-89.
• [4]Grossi E, Borghi C, Cerchiari EL, Della Puppa T, Francucci B: Analogue chromatic continuous scale (ACCS): a new method for pain assessment. Clin Exp Rheumatol 1983, 1:337-340.
• [5]Melzack R: The McGill Pain questionnaire: major properties and scoring methods. Pain 1985, 21:85-92.
• [6]Melzack R, Katz J, Jeans ME: The role of compensation in chronic pain: Analysis using a new method of scoring the McGill Pain Questionnaire. Pain 1985, 23:101-112.
• [7]Maiani G, Sanavio E: Semantics of pain in Italy: the Italian version of the McGill Pain Questionnaire. Pain 1985, 22:399-405.
• [8]Felson DT, Andersen JJ, Boers M, et al.: American College of Rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum 1995, 38:727-735.
• [9]Cavalieri F, Salaffi F, Ferraccioli GF: Relationship between physical impairment, psychological variables and pain in rheumatoid disability. An analysis of their relative impact. Clin Exp Rheumatol 1991, 9:47-50.
• [10]Guillemin F, Briancon S, Pourel J: Functional disability in rheumatoid arthritis: two different models in early and established disease. J Rheumatol 1992, 19:366-369.
• [11]Pincus T, Callahan L, Brooks RH, Fuchs HA, Olsen NJ, Kaye JJ: Self-report questionnaire scores in rheumatoid arthritis compared with traditional physical, radiographic and laboratory measures. Ann Intern Med 1989, 110:259-266.
• [12]Hakala M, Nieminem P, Manelius J: Joint impairment is strongly correlated with disability measured by self-report questionnaires: functional status assessment of individuals with rheumatoid arthritis in a population based series. J Rheumatol 1994, 21:64-69.
• [13]Kaarela K, Sarna S: Correlations between clinical facets of outcome in rheumatoid arthritis. Clin Exp Rheumatol 1993, 11:643-644.
• [14]Möttönen T, Paimela L, Leirisalo-Repo M, Kautiainen H, Ilonen J, Hannonen P: Only high disease activity and positive rheumatoid factor indicate poor prognosis in patients with early rheumatoid arthritis treated with "sawtooth" strategy. Ann Rheum Dis 1998, 57:533-539.
• [15]Sokka T, Kankainen A, Hannonen P: Scores for functional disability in patients with rheumatoid arthritis are correlated at higher levels with pain scores than with radiographic scores. Arthritis Rheum 2000, 43:386-389.
• [16]Van Leeuwen MA, van der Heijde DMFM, van rijswijk MH, Houtman PM, van Riel PLCM, van de Putte LBA, et al.: Interrelationship of outcome measures and process variables in early rheumatoid arthritis: a comparison of radiologic damage, physical disability, joint counts and acute phase reactants. J Rheumatol 1994, 21:425-429.
• [17]Arnett FC, Edworthy SM, Block DA, et al.: The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988, 31:315-324.
• [18]Fries JF, Spitz PW, Young DY: The dimensions of health outcomes: The Health Assessment Questionnaire, disability and pain scales. J Rheumatol 1982, 9:789-793.
• [19]Larsen A, Thoen J: Hand radiography of 200 patients with rheumatoid arthritis repeated after an interval of one year. Scand J Rheumatol 1987, 16:395-401.
• [20]Sokka T, Kautiainen H, Möttönen T, Hannonen P: Work disability in rheumatoid arthritis 10 years after the diagnosis. J Rheumatol 1999, 26:1681-1685.
• [21]Pincus T, Callahan L: Quantitative measures to assess, monitor and predict morbidity and mortality in rheumatoid arthritis. Baillieres Clin Rheumatol 1992, 6:161-191.
• [22]Van der Heide A, Jacobs JWG, Haanen HCM, Bijlsma JWI: Is it possible to predict the first year extent of pain and disability for patients with rheumatoid arthritis? J Rheumatol 1995, 22:1466-1470.
• [23]Van der Heide A, Jocobs JWG, Grietje A, et al.: Physical disability and psychological well being in recent onset rheumatoid arthritis. J Rheumatol 1994, 21:28-32.
• [24]Evers AWM, Kraaimaat FW, Geenen R, Bijlsma JWJ: Determinants of psychological distress and its course in the first year diagnosis in rheumatoid arthritis patients. J Behav Med 1997, 20:489-504.
• [25]Evers AWM, Taal E, Kraaimaat FW, et al.: A comparison of two recently developed health status instruments for patients with arthritis: Dutch-AIMS 2 and IGRL. Br J Rheumatol 1998, 37:157-164.
• [26]Bijlsma JW, Huiskes CJ, Kraamaat FW, Vanderveen MJ, Huber-Bruning O: Relation between patients' own health assessment and clinical and laboratory findings in rheumatoid arthritis. J Rheumatol 1991, 18:650-3.
• [27]Regan-Smith MG, O'Connor GT, Kwoh CK, Brown LA, Olmstead EM, Burnett JB: Lack of correlation between the Steinbrocker staging of hand radiographs and the functional health status of individuals with rheumatoid arthritis. Arthritis Rheum 1989, 32:128-133.
• [28]Fex E, Jonsson K, Johnson U, Eberhardt K: Development of radiographic damage during the first 5–6 years of rheumatoid arthritis: a prospective follow-up study of a Swedish cohort. Br J Rheumatol 1996, 35:1106-1115.
• [29]Wolfe F, Sharp JT: Radiographic outcome of recent-onset rheumatoid arthritis: a 19-year study of radiographic progression. Arthritis Rheum 1998, 41:1571-1582.
• [30]Fries JF: Re-evaluating the therapeutic approach to rheumatoid arthritis: the "sawtooth" strategy. J Rheumatol 1990, 22:12-15.
• [31]Van der Heijde DMFM, van't Hof MA, van Riel PLCM, van Leeuwen MA, van Rijswijk MH, van de Putte LBA: A comparison of validity of single variables and composed indices for measuring disease activity in rheumatoid arthritis. Ann Rheum Dis 1992, 51:177-181.
• [32]Prevoo MLL, van't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LBA, van Riel PLCM: Modified disease activity scores that include twenty-eight-joint counts: development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995, 38:44-48.
• [33]Kirwan JR: Conceptual issues in scoring radiographic progression in rheumatoid arthritis. J Rheumatol 1999, 26:720-725.