High Prevalence of Rheumatic Regional Pain Syndromes in First-Degree Relatives of Patients with Rheumatoid Arthritis

Mature woman holding sore knee.
Researchers described the frequency of rheumatic regional pain syndromes in first-degree relatives of patients with rheumatoid arthritis.

The presence of rheumatic regional pain syndromes (RRPS) was higher in the first-degree relatives (FDRs) of patients with rheumatoid arthritis (RA) vs the general population, according to study results published in Clinical Rheumatology.

Previous studies have showed that the risk of developing RA is significantly higher for FDRs of patients with RA; however, there are limited studies evaluating RRPS in FDR or the stages preceding the development of RA. Using a screening tool, Pérez-Barbosa and colleagues investigated the frequency of RRPS in a selected high-risk population for RA development.

The observational cross-sectional study was performed from July 2016 to September 2018 and enrolled a cohort of FDRs (parents, siblings, and offspring) of patients with RA from a Mexican university hospital. Inclusion criteria were patient self-referral following an invitation by a rheumatologist, and the completion of the Community Oriented Program in the Rheumatic Diseases (COPCORD) questionnaire, with “positive” COPCORD defined by the presence of musculoskeletal pain. Serum levels of rheumatoid factor (RF) isotypes IgA, IgM, and IgG; C-reactive protein (CRP); erythrocyte sedimentation rate (ESR); and anticitrullinated peptide antibodies (ACPAs) were also analyzed. The American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 classification criteria was used to diagnosis RA, and the EULAR recommendations were used to determine inflammatory arthralgia and undifferentiated arthritis.

A total of 335 FDRs referred by 189 patients were included in the study, with an average age of 44.15±14.15 years (75.8% women). Overall, 230 participants (68.9%) reported pain. Analysis revealed that 138 participants (41.2%; 95% CI, 36%-46.4%) were diagnosed with ≥1 RRPS. The shoulder was the most frequently affected site; 21.5 % of participants (95% CI, 17%-26%) had rotator cuff tendinitis, 15.2% (95% CI, 11%-19%) had pes anserine bursitis, 11.6% (95% CI, 8%-15%) had lateral epicondylitis, and 6.9% (95% CI, 4%-10%) had carpal tunnel syndrome. Rheumatoid arthritis was diagnosed in 7.16% of participants, inflammatory arthralgia in 31%, and undifferentiated arthritis in 8.9%. In addition, anti-CCP positivity was identified in 6.8% of participants, RF IgG in 8.9%, RF IgM in 48.6%, and RF IgA in 22.3%.

Study limitations included selection bias and the use of a single institution.

“The clinical evaluation of risk groups for the development of RA as the RA FDR should be intentionally screened to detect RRPS, through a clinical evaluation that includes the squeeze test as well as RF, ACPAs, ESR, and CRP. These [individuals] should be monitored for the risk for RA progression,” the researchers wrote.


Pérez-Barbosa L, Garza-Elizondo MA, Vega-Morales D, Esquivel-Valerio JA, Peláez-Ballestas I, Vázquez-Fuentes BR, et al. High frequency of rheumatic regional pain syndromes in first-degree relatives of patients with rheumatoid arthritis [published online May 9, 2020]. Clin Rheumatol. doi:10.1007/s10067-020-05029-z