Neuropathic component of pain, comorbidity and quality of life in rheumathoid arthritis: are there any relationships?

The quality of life (QL) of patients with rheumatoid arthritis (RA) is associated not only with the disease activity, but also with the presence and severity of pain, as well as with comorbidity. Objective. To determine the nature of pain syndrome in patients with RA and the role of neuropathic component of pain (NCP) in identifying the QL of patients with RA and comorbidity. Material and methods. The study included 163 women with confirmed RA (mean age 53.9±10.2 years, median RA duration 10 [4; 14] years), with moderate and high RA activity (DAS28: 5.2 [4.4; 5.8]). The clinical and laboratory examinations, QL assessment with the use of HAQ and EQ-5D questionnaires and pain evaluation using visual analogue scale were conducted. NCP was identified by means of the DN4 questionnaire. The Charlson, Kaplan-Feinstein and CIRS indices were used to assess the comorbid status of patient. The severity of anxiety and depression was determined by the Hospital Anxiety and Depression Scale (HADS). Results. The presence of NCP has been found in 49.7% of RA patients. When NCP joined, the DAS28 indicator of RA activity became less informative for evaluating the efficacy of therapy in patients with RA. Patients with NCP had significantly higher anxiety/depression level than patients without this component of pain. The higher Charlson, CIRS and Kaplan-Feinstein indices were revealed in patients with NCP. QL in RA patients was worse when the pain was combined with a neuropathic component. Conclusion. Patients with RA have a mixed type of pain. The presence of NCP makes it difficult to assess RA activity. The relationships between the character of pain, anxiety-depressive disorders and comorbidity and QL indices of patients with RA have been found. Preliminary determination of the patient’s pain phenotype before treatment can lead to a better response on it through a personalized approach to therapy.

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