Perspectives on Chronic Widespread Pain in Rheumatoid Arthritis

Summary, in English

Abstract:
Concomitant chronic widespread pain (CWP) in patients with rheumatoid arthritis (RA) continues to be a problem despite modern pharmacological treatment. The overall aim was to investigate factors involved in chronic widespread pain in rheumatoid arthritis.

Study I, compared patients with early RA (duration ≤12 months), in a tight control cohort, with conventionally managed patients. The patients in the tight control had significantly lower 28-joint disease activity score (DAS28), and reported less pain at 3, 6, 12 and 24 months, p ≤ 0.001. Participation in the tight control, was associated with remission and acceptable pain (VAS pain<40) at 24 months.

In Study II, the prevalence of CWP, was investigated at 6-year follow-up, in both a tight control cohort and a conventional cohort of early RA. In the tight control cohort, 10% reported CWP with the 2019 criteria (CWP2019), compared to 23% in the conventional cohort, p=0.026. Participation in the conventional cohort, adjusted for disease duration, gender, age, and VAS pain at inclusion, had an association with CWP2019, OR 2.57 (95%CI 1.02-6.50). A high level of fear-avoidance about physical activity was associated with CWP2019.

Study III examined associations between the adipokine leptin, and CWP2019 in RA. Patients fulfilling CWP2019 had significantly higher leptin levels, waist circumference and BMI. There was a significant association between leptin levels and CWP2019 OR 1.014 (95% CI 1.007-1.020). The significant association remained when adjustments were made for BMI, gender and age.

In Study IV, the circadian rhythm of leptin release was explored in 11 patients with RA and 10 patients with osteoarthritis (OA). A circadian rhythm of leptin release was observed with a peak at night. The two thirds of patients that reported most pain, had numerically higher median leptin levels at all timepoints. The difference was significant or close to significant.

In conclusion, there is a possible connection between leptin and CWP in RA. However, the causes of CWP are multifactorial and factors such as tight control early in the disease course seem to have a potential to limit the development of CWP.

• Författare: Maria Aronsson
• Avdelning/ar: Reumatologi och molekylär skelettbiologi; Spenshults artrit grupp
• Publiceringsår: 2025
• Språk: Engelska
• Publikation/Tidskrift/Serie: Lund University, Faculty of Medicine Doctoral Dissertation Series
• Avvikelse: 2025:101
• Fulltext: - 3 MB; Download statistics
• Dokumenttyp: Doktorsavhandling
• Förlag: Lund University, Faculty of Medicine
• Ämne: Rheumatology
• Nyckelord: pain RA leptin CWP
• Aktiv: Published
• Forskningsgrupp: Spenshults arthritis group
• Handledare: Maria Andersson; Elisabet Lindqvist; Stefan Bergman
• ISBN/ISSN/Övrigt: ISSN: 1652-8220; ISBN: 978-91-8021-754-5
• Försvarsdatum: 10 oktober 2025
• Försvarstid: 09:00
• Försvarsplats: Reumatologiska klinikens föreläsningssal, Lottasalen, Kioskgatan 5, Skånes Universitetssjukhus i Lund. Join by Teams: https://teams.microsoft.com/l/meetup-join/19%3ameeting_ZjQyNTE5YmUtYjkxNC00OTljLWFjYmMtMmFlYTg3Y2YxYmU3%40thread.v2/0?context=%7b%22Tid%22%3a%226585ed5f-93d5-40d1-8dfb-48df526ff0f7%22%2c%22Oid%22%3a%225f282f28-b5d0-42f3-bcf0-a9a040e8fba4%22%7d
• Opponent: Jan Bjersing (MD, Associate Professor)