A subgroup of patients with rheumatoid arthritis (RA) were found to have high levels of pain, fatigue, and psychosocial distress 3 years after diagnosis, according to study results published in ACR Open Rheumatology.

The researchers sought to identify subgroups of patients with RA, according to their health status, 3 years after diagnosis, and evaluate potential associations with clinical presentation at diagnosis.

An observational case-control study was conducted that included patients with RA and 3-year follow-up data from the Swedish Epidemiological Investigation of RA (EIRA) study between 2011 and 2018.

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Researchers used hierarchic agglomerative cluster analysis, based on symptoms of pain, fatigue, mood disturbances, sleep quality, and overall health-related quality of life to identify subgroups of patients with RA 3 years after diagnosis.

A total of 1055 individuals were included in the study population, 1011 (73% women; median age, 58 years) of whom were eligible for inclusion, based on available data.

Researchers identified 3 clusters, including cluster 1 (n=466; 46%) with patients with a good health status; cluster 2 (n=398; 39%) with patients in an intermediate group; and cluster 3 (n=147; 15%) with patients with high levels of pain and fatigue, along with markedly impaired mental and physical health.

Results of the study showed that cluster 3 vs cluster 1 was associated with higher levels of baseline pain (risk ratio [RR], 3.71; 95% CI, 2.14-6.41), global health (RR, 6.60; 95% CI, 3.53-12.33), and the Stanford Health Assessment Questionnaire (RR, 4.40; 95% CI, 2.46-7.87). An inverse association was observed for baseline swollen joint count (RR, 0.51; 95% CI, 0.34-0.85).

One of the study limitations was the fact that cluster 2 was a disperse subgroup of individuals who did not form a coherent cluster. Another limitation was the potential recall bias of retroactively reported pain issues prior to RA, such that the effect of inflammatory disease activity on health status at 3 years could not be evaluated.

The researchers concluded, “The display of characteristic features at diagnosis suggests that factors related to long-term pain and fatigue are already prevalent at this early stage of disease, which signals that the early identification of patients at risk and the adoption of targeted interventions should be a future priority in the management of these unmet needs in RA.”


Lindqvist J, Alfredsson L, Klareskog L, Lampa J, Westerlinkd H. Unmet needs in rheumatoid arthritis: a subgroup of patients with high levels of pain, fatigue, and psychosocial distress 3 years after diagnosis. ACR Open Rheumatol. Published online March 9, 2022. doi:10.1002/acr2.11422