Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: A longitudinal observational study

Arthritis Research & Therapy, 06/10/2011

Lee YC et al. – Clinically significant pain continues among a substantial proportion of patients in DAS28 remission but not among those in ACR/EULAR remission. Among patients in DAS28 remission, patient global assessment, disability, fatigue, sleep problems and self-efficacy are strongly associated with pain severity at baseline and one year, whereas inflammatory disease activity and joint damage are not significantly associated with elevated pain severity at either baseline or one-year.


  • Data analyzed from RA patients in Brigham Rheumatoid Arthritis Sequential Study with data at baseline and 1 year
  • DAS28 remission defined as DAS28-CRP4 < 2.6
  • ACR/EULAR remission criteria included: 1) [less than or equal to] 1 swollen joint, 2) [less than or equal to] 1 tender joint, 3) CRP [less than or equal to] 1 mg/dl and 4) patient global assessment score [less than or equal to] 1
  • Pain severity measured using pain score from Multi-Dimensional Health Assessment Questionnaire (MDHAQ)
  • Associations between baseline clinical predictors and MDHAQ pain at baseline and 1-year assessed using multivariable linear regression


  • Among 865 patients with data at baseline and 1-year, 157 (18.2%) met DAS28-CRP4 remission criteria at both time points
  • 37 (4.3%) met ACR/EULAR remission criteria at baseline and 1-year
  • Prevalence of clinically significant pain (MDHAQ pain [greater than or equal to] 4) at baseline ranged from 11.9% among patients meeting DAS28-CRP4 remission criteria to 0% among patients meeting ACR/EULAR remission criteria
  • Patient global assessment, MDHAQ function, MDHAQ fatigue, MDHAQ sleep and arthritis self-efficacy were significantly associated with MDHAQ pain in cross-sectional (P [less than or equal to] 0.0005) and longitudinal analyses (P [less than or equal to] 0.03)
  • Low swollen joint counts associated with high MDHAQ pain in longitudinal analyses (P = 0.02) but not cross-sectional analyses
  • Other measures of inflammatory disease activity and joint damage were not significantly associated with MDHAQ pain at baseline or at 1-year

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