Trajectories of self-reported pain-related health outcomes and longitudinal effects on medication use in rheumatoid arthritis: a prospective cohort analysis using the Australian Rheumatology Association Database (ARAD)

Huai Leng Pisaniello; Susan Lester; Oscar Russell; Rachel Black; Joanna Tieu; Bethan Richards; Claire Barrett; Marissa Lassere; Lyn March; Rachelle Buchbinder; Samuel L Whittle; Catherine L Hill

doi:10.1136/rmdopen-2022-002962

Trajectories of self-reported pain-related health outcomes and longitudinal effects on medication use in rheumatoid arthritis: a prospective cohort analysis using the Australian Rheumatology Association Database (ARAD)

RMD Open. 2023 Jul;9(3):e002962. doi: 10.1136/rmdopen-2022-002962.

Authors

Huai Leng Pisaniello^{1

2}, Susan Lester^{2

3}, Oscar Russell^{4

2

3}, Rachel Black^{2

3}, Joanna Tieu^{2

3}, Bethan Richards^{5

6

7}, Claire Barrett^{8

9}, Marissa Lassere^{10

11}, Lyn March^{12

13}, Rachelle Buchbinder¹⁴, Samuel L Whittle^{2

3

14}, Catherine L Hill^{2

3}

Affiliations

¹ Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia huaileng.pisaniello@adelaide.edu.au.
² Rheumatology Research Group, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
³ Deaprtment of Rheumatology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
⁴ Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
⁵ Department of Rheumatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
⁶ Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.
⁷ Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁸ Department of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
⁹ Department of Rheumatology, Redcliffe Hospital, Redcliffe, Queensland, Australia.
¹⁰ Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
¹¹ Department of Rheumatology, St George Hospital, Kogarah, New South Wales, Australia.
¹² Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
¹³ Department of Rheumatology, Institute of Bone and Joint Research at Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
¹⁴ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.

Abstract

Objective: To determine distinct trajectories of self-reported pain-related health status in rheumatoid arthritis (RA), their relationship with sociodemographic factors and medication use.

Methods: 988 Australian Rheumatology Association Database participants with RA (71% female, mean age 54 years, mean disease duration 2.3 years) were included. Distinct multi-trajectories over 15-year follow-up for five different self-reported pain-related health outcome measures (Health Assessment Questionnaire Disability Index, visual analogue scores for pain, arthritis, global health and the Assessment of Quality of Life utility index) were identified using latent variable discrete mixture modelling. Random effects models were used to determine associations with medication use and biologic therapy modification during follow-up.

Results: Four, approximately equally sized, pain/health status groups were identified, ranging from 'better' to 'poorer', within which changes over time were relatively small. Important determinants of those with poorer pain/health status included female gender, obesity, smoking, socioeconomic indicators and comorbidities. While biologic therapy use was similar between groups during follow-up, biologic therapy modifications (p_linear<0.001) and greater tendency of non-tumour necrosis factor inhibitor use (p_linear<0.001) were observed in those with poorer pain/health status. Similarly, greater use of opioids, prednisolone and non-steroidal anti-inflammatory drugs was seen in those with poorer pain/health status.

Conclusion: In the absence of disease activity information, distinct trajectories of varying pain/health status were seen from the outset and throughout the disease course in this RA cohort. More biologic therapy modifications and greater use in anti-inflammatories, opioids and prednisolone were seen in those with poorer pain/health status, reflecting undesirable lived experience of persistent pain in RA.

Keywords: arthritis, rheumatoid; epidemiology; patient reported outcome measures.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Analgesics, Opioid
Antirheumatic Agents* / therapeutic use
Arthritis, Rheumatoid* / complications
Arthritis, Rheumatoid* / drug therapy
Arthritis, Rheumatoid* / epidemiology
Australia / epidemiology
Cohort Studies
Female
Humans
Male
Middle Aged
Outcome Assessment, Health Care
Pain / drug therapy
Pain / epidemiology
Pain / etiology
Prednisolone / therapeutic use
Prospective Studies
Quality of Life
Rheumatology*
Self Report

Substances

Analgesics, Opioid
Antirheumatic Agents
Prednisolone