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The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: A cross-sectional study
Arthritis Research & Therapy, 11/02/09

Lee YC et al. –Multivariable models are essential in analyses of pain. Among RA patients, inflammation is associated with heightened pain sensitivity at joints. In contrast, poor sleep is associated with diffuse pain sensitivity, as noted in central pain conditions such as fibromyalgia. Future studies examining pain sensitivity at joint and non-joint sites may identify patients with different underlying pain mechanisms and suggest alternative approaches.

• 59 female RA patients completed questionnaires and underwent pressure pain threshold testing to assess hyperalgesia/allodynia at joint and non-joint sites
• Blood samples taken to measure CRP
• Association between disease activity, sleep problems, psychiatric distress and pain threshold assessed using Pearson/Spearman correlations and multivariable linear regression
• Disease activity levels, sleep problems and psychiatric distress compared between RA patients with fibromyalgia and RA patients without fibromyalgia

• In unadjusted analyses, CRP not correlated with pain threshold, but tender joint count inversely correlated with pain threshold at all sites
• Sleep problems associated with low pain threshold at all sites
• Psychiatric distress associated with low pain threshold at wrist and thumbnail
• In multivariable linear regression models, CRP inversely associated with wrist pain threshold
• Sleep problems inversely associated with pain threshold at all sites , but psychiatric distress was not
• Despite differences in pain threshold, CRP levels and sleep problems between RA patients with fibromyalgia and those without fibromyalgia, associations between these variables did not change when patients with fibromyalgia excluded

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