Inclusion of Pain and Fatigue in the Assessment of Disease Status in Early RA

Rheumatoid arthritis
Rheumatoid arthritis
Researchers assessed the possibility of integrating pain, fatigue, and physical function in the evaluation of disease status in early rheumatoid arthritis.

Patient-reported outcomes measures, including pain, fatigue, and physical function, may be included in the evaluation of disease status in early rheumatoid arthritis (RA), according to study results published in The Journal of Rheumatology.

Although inflammation of the peripheral joints is the primary clinical manifestation of RA, a wide range of symptoms, including functional impairment and fatigue, may present among patients with RA. In addition, among patients in remission or with low disease activity, residual symptoms may persist and have a significant effect on quality of life.

The objective of the current study ( Identifier: NCT01172639) was to determine the possibility of incorporating patient-reported outcomes, including pain, fatigue and physical function, into the assessment of disease status in patients with early RA. Researchers used visual analog scales to measure pain and fatigue; Health Assessment Questionnaire (HAQ), physician and patient global health, and standard disease activity scores were recorded at every visit.

The study cohort included 379 patients (mean age, 53.9±13 years; 69% women) from the Care in Early RA (CareRA; EudraCT Number: 2008-007225-39) trial.

Data analyses indicated that patient global health was influenced by factors not directly related to disease activity, including pain, fatigue, and physical function. A strong correlation was observed between pain and patient global health (Pearson correlation, 0.83). Furthermore, fatigue and HAQ were also strongly correlated with patient global health (Pearson correlations, 0.65 and 0.59, respectively).              

Overall, a 3-factor model, that included patient perception, along with clinical data and laboratory assessment, provided the best representation of the disease status. The addition of patient-reported outcomes to standard measurements for assessing disease activity in patients with RA provided a more comprehensive picture of the disease burden.

“Based on the 3-factor analysis, a broader perspective of the patients’ self-evaluation could be taken into account, including patient-important outcomes such as pain, fatigue, and physical function, while preserving the validity of the existing scale,” the researchers concluded.


Pazmino S, Lovik A, Boonen A, et al. Does including pain, fatigue, and physical function when assessing patients with early rheumatoid arthritis provide a comprehensive picture of disease burden? J Rheumatol. doi:10.3899/jrheum.200758