Pain Remains a Significant Issue for Women With RA in Modern Treatment Era
Alice Goodman
June 17, 2010 (Rome, Italy) — A large international survey reported here at the European League Against Rheumatism (EULAR) Congress 2010 shows that pain remains a major issue for patients with rheumatoid arthritis (RA), despite the availability of modern disease-modifying therapies.
Pain compromises patients' ability to work, function in their daily activities, and has a negative impact on emotional wellbeing and relationships. Investigators report that the survey also showed that fatigue was prevalent and compromised their lives.
"This survey has touched the tip of a very large iceberg," said Vibeke Strand, MD, associate professor at Stanford University in Palo Alto, California. "Pain is a paramount issue for RA patients, and I'm surprised that this is the case with current treatments," she said.
"It is not that surprising that these women have some degree of pain, but the extent of pain they report is impressive. The results suggest that we are not doing a good job, or as good a job as I thought we were, in controlling patients' pain."
The Good Days survey was sent to 27,459 women 25 to 65 years of age who had been formally diagnosed with RA at least 6 months earlier. Respondents were recruited over the Internet. Between July 30 and August 1, 2009, 1958 women completed the survey. Mean age was 46 years, 75% had RA for more than 1 year, and 69% had moderate to severe RA (57%, moderate; 12%, severe).
A substantial percentage of respondents reported pain: 63% reported daily pain, 75% were taking pain medications, and 87% had discussed their pain with caregivers. The survey results suggested that patients were dissatisfied with their current medications in terms of pain relief; 75% with moderate to severe pain were seeking new medications and two thirds were seeking new ideas to help with their pain.
Pain also interfered with their ability to exercise. About 50% said that keeping fit was too painful, 45% reported that gardening was too painful, and 32% said that outdoor activities were too painful.
Pain had a negative effect on work function in 70% of the 1108 women who were employed. Two thirds of respondents said they were less self-confident at work, 23% had to stop working, and 17% were working part time.
Other daily activities were also adversely affected by pain. Forty percent of the women found housework too painful, 28% found shopping too painful, and 24% had their sleep compromised by pain.
"Overall, 60% said that pain interfered with their ability to perform activities of daily living," Dr. Strand told conference attendees.
Although the survey was designed to assess the impact of pain, responses to the question, "What is your definition of a good day," revealed that fatigue was a significant problem for more than half of respondents. In response to this question, 57% said "pain-free" and 58% said "fatigue-free."
Pain adversely affected patients' emotional lives, Dr. Strand reported. Three quarters of the women worried about losing their independence, 68% concealed pain from families and friends, and 56% found RA "distressing." A substantial percentage of patients reported associated depression, and 37% said that RA "robbed them of happiness."
The study had several limitations, Dr. Strand acknowledged. It was based on self-reports and a small sample size. Also, the method of recruitment had a built-in bias. Nevertheless, the findings were consistent across the 7 different countries participating in this survey, and a German survey of RA patients found similar results, Dr. Strand said.
"These findings should be taken into account when managing RA patients," she asserted.
David Magnusson, PhD, from the University of Stockholm, Sweden, who moderated the session where the survey results were presented, said that there is a connection between pain and fatigue in RA patients, as this survey suggests, but it is not clear whether pain influences fatigue or vice versa. The survey was not designed to answer this question, Dr. Strand explained.
Dr. Magnusson suggested that taking painkillers and the lack of a good night's sleep could cause fatigue. "The findings of this study open many areas for research," he noted.
Responding to these findings, Paul Emery, MD, president of EULAR and professor of rheumatology at Leeds Institute of Molecular Medicine, University of Leeds, United Kingdom, said that "the adoption of treatment pathways and strategies to reduce pain, reinstate productivity at work, and manage the social impact of RA is of huge importance in the management of this patient population."
The study was funded by UCB. Dr. Strand is a consultant for UCB, Abbott Immunology, Alder, Almirall, Amgen, AstraZeneca, Biogen Idec, CanFite, Centocor, Crescedo, Cypress Biosciences, Euro Diagnostica, FibroGen, Forest Labs, Genentech, Human Genome Sciences, Idera, Incyte, Jazz Pharmaceuticals, Lexicon Genetics, Logical Therapeutics, Lux Biosciences, Novartis Pharmaceuticals, Novo Nordisk, Nuon, Ono Pharmaceuticals, Pfizer, Rigel, Roche, Sanofi-Aventis, Savient, Schering Plough, and SKK. Dr. Magnusson has disclosed no relevant financial relationships. Dr. Emery reports receiving grant/research support from UCB.
European League Against Rheumatism (EULAR) Congress 2010: Abstract OP002. Presented June 16, 2010.