Enhanced pain perception in rheumatoid arthritis: Novel considerations

Enhanced pain perception is common among patients with rheumatoid arthritis (RA). Given the putative role of proinflammatory cytokines in the development of hyperalgesia, a greater understanding of factors that facilitate increased cytokine expression in RA stands to increase understanding of the sources of enhanced pain perception. Patients with RA have significantly greater stress-induced proinflammatory cytokine release. Although absolute deficiencies in cortisol have not been demonstrated, functional abnormalities have been described, including “abnormally normal” cortisol levels in the face of increased inflammation and deficient responses to stressful challenges. Parasympathetic insufficiency has also been demonstrated, which may enhance pain perception indirectly through disinhibited cytokine expression. Several psychological variables have also been demonstrated to affect pain perception in patients with RA. Identification of factors that contribute to enhanced pain perception in RA may aid in the development of novel analgesic strategies that, in turn, may decrease disease activity and improve general clinical outcomes.     

健康教育对类风湿关节炎患者治疗依从性及疼痛的影响

目的探讨健康教育在类风湿性关节炎中的应用效果。方法将60例类风湿性关节炎患者随机分为观察组和对照组,对照组仅进行用药指导,观察组按照护理程序加强健康教育,比较2组的治疗情况、效果及生活质量。结果观察组的健康知识掌握率高于对照组,用药依从性、关节锻炼依从性、定期复查依从性等方面均高于对照组,疗效优于对照组,疼痛评分低于对照组,差异均有统计学意义(P0.05)。观察组在物质功能、心理功能和社会功能等方面的生活质量高于对照组,差异有统计学意义(P0.05)。结论健康教育加强了类风湿患者对自身健康的重视,提高了治疗的依从性和效果,改善了生活质量。     

Efficacy,tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome,back pain,osteoarthritis, rheumatoid arthritis)

Background

In the absence of an ideal treatment for chronic pain associated with rheumatic diseases, there is interest in the potential effects of cannabinoid molecules, particularly in the context of global interest in the legalization of herbal cannabis for medicinal use.

Methods

A systematic search until April 2015 was conducted in Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, www.cannabis-med.org and clinicaltrials.gov for randomized controlled trials with a study duration of at least 2 weeks and at least ten patients per treatment arm with herbal cannabis or pharmaceutical cannabinoid products in fibromyalgia syndrome (FMS), osteoarthritis (OA), chronic spinal pain, and rheumatoid arthritis (RA) pain. Outcomes were reduction of pain, sleep problems, fatigue and limitations of quality of life for efficacy, dropout rates due to adverse events for tolerability, and serious adverse events for safety. The methodology quality of the randomized controlled trials (RCTs) was evaluated by the Cochrane Risk of Bias Tool.

Results

Two RCTs of 2 and 4 weeks duration respectively with nabilone, including 71 FMS patients, one 4-week trial with nabilone, including 30 spinal pain patients, and one 5-week study with tetrahydrocannbinol/cannabidiol, including 58 RA patients were included. One inclusion criterion was pain refractory to conventional treatment in three studies. No RCT with OA patients was found. The risk of bias was high for three studies. The findings of a superiority of cannabinoids over controls (placebo, amitriptyline) were not consistent. Cannabinoids were generally well tolerated despite some troublesome side effects and safe during the study duration.

Conclusions

Currently, there is insufficient evidence for recommendation for any cannabinoid preparations for symptom management in patients with chronic pain associated with rheumatic diseases.

     

Individual differences in emotional processing and reactivity to pain among older women with rheumatoid arthritis

The purpose of the current study was to determine whether the relationship between pain and emotion may be better understood by identifying people who are more vulnerable to emotional dysregulation and those who are able to regulate emotion. Data were collected from 81 women diagnosed with rheumatoid arthritis. We assessed affect intensity, emotion regulation, active coping, neuroticism as well as weekly reports of pain, positive affect, and negative affect. Results indicated that the joint effects of emotion regulation and emotional intensity predicted emotional responses to pain. The current study suggests that the emotional impact of pain is related to emotional intensity which can be tempered by the ability to regulate emotion.     

青年慢性下腰痛患者腰背肌耐力比较研究

目的 :研究青年下腰痛患者腰背肌耐力的变化。方法 :应用CYBEX - 6 0 0 0型等速测试训练系统和肌电图测试腰痛组 (n =4 0 )和正常组 (n =4 0 )的腰背肌耐力指标 ,进行两组间比较。结果 :腰痛组腰背肌耐力比与正常组无差异 (P >0 .0 5 ) ;腰痛组腰背肌肌电图波幅低于正常组 (P <0 .0 5 )、时程大于正常组 (P <0 .0 5 ) ,腰痛组腰背肌肌电图波幅随时间衰减程度大于正常组 (P <0 .0 5 )、时程随时间延长程度大于正常组 (P <0 .0 5 )。结论 :青年下腰痛患者存在着明显的腰背肌静态耐力下降 ,腰背肌耐力比与下腰痛关系并不密切。     

Age, pain, and coping with rheumatoid arthritis.

The purpose of this study was to examine the relationship of age and pain severity (i.e. mild versus severe pain) in predicting coping strategies of individuals with rheumatoid arthritis (RA). An age-stratified sample (N = 121) of individuals diagnosed with rheumatoid arthritis completed a modified version of the Coping Strategies Questionnaire (CSQ). Individuals were asked to report the coping strategies used for mild versus severe pain. Findings included: (1) older adults were more likely than younger adults to report use of maladaptive coping strategies in the context of mild, but not severe, RA pain, (2) older adults' reported patterns of coping reflected less-than-anticipated expertise in dealing with RA pain, and (3) individuals, regardless of age, reported use of more active coping strategies in the context of mild pain and use of more maladaptive coping strategies in the context of severe pain. The present study suggests that research regarding illness and coping is most informative when it captures the individual-situational interaction of dealing with stressors such as chronic pain.     

A cross-cultural study of pain intensity in Egyptian and Dutch women with rheumatoid arthritis.

It has been suggested that patients from Mediterranean cultures tend to report more intense pain than their Northern or Western European counterparts in comparable medical conditions. However, empirical data to support this hypothesis are limited. The goals of the present study were to examine differences in pain intensity reports between Dutch and Egyptian women with rheumatoid arthritis (RA) and to examine the influence of possible confounding variables using multivariate analyses. We performed a cross-sectional study in 30 Dutch and 42 Egyptian women with comparable RA, matched for age and disease duration. Pain intensity was measured on a 100-mm graphic rating scale. Additionally, we assessed physical function, radiographic joint damage, progression of RA, disease activity, number of swollen and tender joints, medication, rheumatoid factor, and socioeconomic variables. The progression of RA and radiographic damage were not significantly different between Egyptian and Dutch patients. However, the Egyptian population reported significantly worse pain and physical function and demonstrated higher disease activity. Multiple linear regression analysis showed that the country of residence and the number of tender and swollen joints were significant independent determinants of pain reports. The results provide some support for the idea that there are ethnocultural differences in pain reports between Egyptian and Dutch women with RA, although the mechanisms underlying these differences remain unclear. PERSPECTIVE: This article shows that after controlling for differences in demographic, socioeconomic, and clinical variables, Egyptian women with RA reported more pain than Dutch women with RA. Clinicians and investigators should recognize that cultural or ethnic factors may play an important role in patients' pain reports.     

The relationship of arthritis self-efficacy to daily pain, daily mood, and daily pain coping in rheumatoid arthritis patients

There is an increasing awareness in the medical community that psychosocial variables such as beliefs in self-efficacy are important determinants of treatment outcome. However, before measures of self-efficacy are widely incorporated into clinical practice, there needs to be a better understanding of how they relate to daily pain, mood and coping. In the present study 128 rheumatoid arthritis patients completed diaries for 30 days in which they provided daily ratings of joint pain, negative and positive mood, the use of pain coping strategies, and coping efficacy. The patients then participated in an evaluation session during which measures of self-efficacy (the Arthritis Self Efficacy Scale (ASES)), demographic variables, and medical status were collected. A series of hierarchical regression analyses was conducted to determine the degree to which self-efficacy measures collected at the time of the evaluation session were related to daily diary measures collected during the 30 preceding days. The results revealed that self-efficacy was significantly related to daily ratings of pain, mood, coping and coping efficacy. Interestingly, the findings regarding self-efficacy were obtained even after taking into account the effects of important demographic and medical status variables. Taken together, these results suggest that self-efficacy ratings collected from arthritis patients at the time of an evaluation session may well be related to recent experiences of daily pain and mood, as well as the daily use and perceived effectiveness of pain coping strategies.     

Physical and emotional functioning of adult patients with chronic abdominal pain: comparison with patients with chronic back pain.

Adults with chronic abdominal pain remain a poorly defined population, despite the debilitation and depression associated with this therapeutically challenging condition. This study compared patients with chronic abdominal pain with an empirically well-known group of patients with chronic pain (back pain) to investigate similarities and differences in their physical and mental functioning. This retrospective, cross-sectional study included 136 patients with abdominal pain and 364 patients with back pain seen in a comprehensive pain rehabilitation center. Patients' functioning was assessed with the Short Form-36 Health Survey, Multidimensional Pain Inventory, Center for Epidemiological Studies-Depression scale, and Coping Strategies Questionnaire-Catastrophizing subscale. Both the abdominal and back pain patients reported long-standing and severe pain, numerous surgery procedures, poor functioning, and high prevalence of depression. When age, education, and marital status were controlled for, analyses showed that although patients with abdominal pain reported significantly better physical functioning than patients with back pain (P < .001), their overall health perception was significantly poorer (P < .001). Although less prevalent, it is clear that patients with chronic abdominal pain exhibit poor functioning and prevalence of depression that are comparable to patients with chronic back pain. This study also suggests distinct characteristics that are vital to consider for effective treatment of this chronic pain population. PERSPECTIVE: As a result of being an overlooked and poorly defined population, adults with chronic abdominal pain might not receive adequate pain management treatment. Learning more about the physical and emotional functioning of patients with long-standing abdominal pain can increase recognition of the needs of and improve treatment for this population.     

基于互联网模式的健康教育在类风湿关节炎患者中的应用

目的:探讨基于互联网模式的健康教育在类风湿关节炎（RA）患者中的应用效果。方法:采用便利抽样法,选取2019年1月—2020年1月在新乡市中心医院接受治疗的296例RA患者,按随机数字表法分为对照组与观察组,各148例。对照组给予常规健康教育干预,观察组给予基于互联网模式的健康教育干预。比较两组干预后的治疗依从性、慢性...     

Region-specific foot pain and plantar pressure in people with rheumatoid arthritis: A cross-sectional study

BackgroundIt is unclear whether region-specific foot pain may influence plantar pressure in people with established rheumatoid arthritis. The aim was to determine the association between region-specific foot pain and region-specific plantar pressure.MethodsTwenty-one people with rheumatoid arthritis and 19 age- and sex-matched controls participated in this study. Self-reported foot pain in the toes, forefoot, midfoot and rearfoot was assessed using foot diagrams. Peak pressure and pressure time integrals for the toes, forefoot, midfoot and rearfoot were calculated using a pressure mat system. Differences in foot pain and pressure between the groups were calculated using appropriate regression models. To determine associations between region-specific pain and pressure, linear regression models were used while adjusting for body mass and participant group.Findings.Participants with rheumatoid arthritis were primarily elderly female with long disease duration. Compared to controls, participants with rheumatoid arthritis had higher odds of foot pain at the toes (Odds Ratio (OR) = 10.4, P = 0.001), forefoot (OR = 6.3, P = 0.006) and rearfoot (OR = 10.1, P = 0.011). Participants with RA had higher peak pressure at the rearfoot (P = 0.003) and higher pressure time integrals at the forefoot (P = 0.005), midfoot (P = 0.016) and rearfoot (P < 0.001). After adjusting for body mass and participant group, peak pressure was significantly higher at the toes in those with midfoot pain and rearfoot pain.InterpretationPeople with rheumatoid arthritis experience region-wide foot pain and demonstrate differences in pressure distribution compared to people without rheumatoid arthritis. Foot pain at the midfoot and rearfoot is also associated with increases in plantar pressure at the toes.     

Twelve-week study of etodolac, aspirin, and placebo in patients with rheumatoid arthritis

Etodolac, aspirin, and placebo were evaluated for efficacy and safety in 20 patients with adult-onset active rheumatoid arthritis who entered a 12-week, double-blind, parallel-group study divided into drug titration and maintenance periods and preceded by a two-week washout period. During the maintenance period the mean daily doses of etodolac and aspirin were 319 mg and 4,701 mg, respectively. At the end of the study, patients treated with etodolac showed significant improvement from baseline values in seven of ten clinical variables, namely, painful joints, swollen joints, articular index, pain intensity, morning stiffness, and investigator's and patient's overall assessments. In patients treated with aspirin, only pain intensity was lessened significantly; in those treated with placebo, only pain intensity lessened significantly and only the patient's overall assessment improved significantly. No serious side effects were noted in patients treated with etodolac. Three patients treated with aspirin were withdrawn from the study because of adverse reactions--two experienced gastrointestinal side effects and one had elevated liver enzyme levels.     

骨科慢性疼痛患者疼痛灾难化与疼痛强度、情绪状态的关系

目的 了解骨科慢性疼痛患者疼痛灾难化现状,探索疼痛强度、情绪状态与疼痛灾难化的关系。方法 采用方便抽样的方法选择某三甲医院骨科慢性疼痛患者262例作为研究对象,采用一般资料调查表、疼痛数字评分表(number rating scale,NRS)、疼痛灾难化量表(pain catastrophizing scale,PCS)、正性负性情绪量表(positive and negative affect schedule,PANAS)对其进行调查。结果 骨科慢性疼痛患者NRS、PANAS和PCS评分分别为(6.59±2.31)、(64.94±11.45)和(34.51±9.63)分。不同居住方式、是否有配偶的患者间PCS得分比较,差异均有统计学意义(t=2.021,P=0.042; t=2.724,P=0.012),PCS和NRS、PANAS-PA、PANAS-NA间的相关系数(r)分别为0.397、-0.325和0.388(均P<0.01),多元线性回归结果显示疼痛强度和情绪状态对疼痛灾难化具有预测作用。结论 骨科慢性疼痛患者疼痛强度、情绪状态和疼痛灾难化呈中等程度相关,疼痛干预、增强社会支持和负性情绪与积极心理干预是减低疼痛灾难化的可能措施。     

抗环瓜氨酸肽抗体检测在类风湿性关节炎的临床应用研究

目的探讨抗环瓜氨酸肽抗体(抗CCP抗体)检测在类风湿性关节炎(RA)患者的诊断及临床意义。方法研究对象为211例RA患者及对照组为40例健康体检者,采用ELIAS法检测抗CCP抗体、速率散射比浊法检测类风湿因子(RF),并对其结果进行回顾性分析。结果①211例RA患者检测抗CCP抗体和RF结果阳性率分别为73.93%(156/211)和63.51%(134/211),其分别与对照组比较,经χ2检验,P<0.01结果均有非常显著性意义,抗CCP抗体与RF组间比较,则P<0.05结果有显著性意义。②211例RA患者及对照组检测RF结果分别为113.28±218.5IU/ml和9.24±15.02IU/ml,结果组间比较,经t检验,P<0.01结果有非常显著性意义。结论抗CCP抗体与RA病情严重程度及其发展有关,可作为RA临床检测新的血清学指标。与RF联合检测,再结合临床症状可提高RA的检出率,抗CCP抗体检测用于早期诊断,对RA早期诊断具有非常重要的临床意义。