More Stringent Definitions of Chronic Widespread Pain Identify Severe Pain Among Patients With Rheumatoid Arthritis

elderly woman with neck pain. fatigue
Researchers studied chronic widespread pain with the 1990 (CWP1990) and 2019 (CWP2019) criteria, a total of 6 years after the onset of rheumatoid arthritis.

More stringent criteria to define chronic widespread pain (CWP) may identify severe pain among patients with rheumatoid arthritis (RA), according to study results published in Clinical Rheumatology.

Because of discrepancies in the CWP1990 criteria to identify patients with chronic pain and fibromyalgia, more stringent criteria were established in 2019 (CWP2019). Overall, studies examining the prevalence of chronic pain, defined by CWP1990 and CWP2019 criteria, among patients with RA are lacking.

Researchers of the current study sought to investigate the prevalence of CWP1990 and CWP2019, a total of 6 years after the onset of RA. They compared 2 patient cohorts — 1 with tight control and the other with conventional follow-up early in the disease course. Researchers also explored factors affecting the reporting of CWP1990 and CWP2019.

Both cohorts included patients with RA with a symptom duration of less than 13 months. The tight-control cohort (n=80) included patients with an early-onset of RA diagnosed between 2001 and 2016. Patients were monitored with monthly follow-ups during the first 6 months, followed by visits at 9, 12, and 24 months. The conventional cohort (n=101) included patients with early-onset of RA diagnosed between 2001 and 2006. Patients in this group were followed-up every 3 months during the first 6 months and then at 12 and 24 months.

Patients from both cohorts were sent questionnaires examining pain and fatigue on a visual analog scale (VAS) and patient-reported diagnosis of fibromyalgia, including pain mannequin 6 years after disease onset. In addition, patients from the conventional cohort received the Swedish version of Stanford Health Assessment Questionnaire (HAQ) and the EuroQol 5 dimensions (EQ-5D). Patients from the tight-control cohort received Fear-Avoidance Beliefs Questionnaire (FABQ), Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), and questions on physical activity. The response rate was 83% and 74% for the conventional and tight-control cohorts, respectively.

The study results reported an overall lower prevalence of CWP in the tight-control group after 6 years; 10% had CWP2019 the tight-control group compared with 23% in the conventional cohort (P =.026). The CWP1990 prevalence was similar with 27% and 31% in the tight-control and conventional cohorts, respectively (P =.546).

After adjusting for age, sex, disease duration, and VAS pain, the odds ratio (OR) for having CWP2019 were more than twice as high in the conventional cohort (OR, 2.57; 95% CI, 1.02-6.50) than the tight-control cohort (P =.046). A similar pattern was not observed for CWP1990.

In the tight-control cohort, a high level of fear-avoidance behavior toward physical activity was associated with CWP2019 (OR, 10.66; 95% CI, 1.01-112.14), but not with CWP1990.

Study limitations included the lack of randomization and different time frames of the 2 study cohorts.

Researchers concluded, “Tight control management of patients with early RA have a positive potential to reduce the prevalence of the more stringent CWP2019 and that patients [with RA] with a fear-avoidance behavior towards physical activity are at increased risk of having CWP2019.”


Aronsson M, Bergman S, Lindqvist E, Andersson MLE. Comparison of chronic widespread pain prevalence with different criteria in two cohorts of rheumatoid arthritis.. Clin Rheumatol. Published November 23, 2021. doi:10.1007/s10067-021-05999-8