Alternative approaches to pain management in rheumatoid arthritis warranted


  • Heather Mason
  • Univadis Medical News
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Results from the Swedish FarmacOTherapy (SWEFOT) trial, reported in Arthritis Care & Research, showed that adding infliximab (IFX), rather than sulfasalazine and hydroxychloroquine (SSZ+HCQ), to methotrexate (MTX) reduced cumulative pain and unacceptable pain at 21 months in patients with rheumatoid arthritis (RA).

Patients with new-onset (RA) who did not reach low disease activity on the 28-joint Disease Activity Score (DAS28≤3.2), following three months of MTX, were randomised to adding IFX (N=128) or SSZ+HCQ (N=130). Pain, outcomes were measured by the Visual Analogue Scale (VAS). Between-group differences of pain, unacceptable pain (>40mm), unacceptable pain despite inflammation control (refractory pain; >40mm+C-reactive protein

At randomisation, 50 per cent of patients (N=258) reported unacceptable pain, declining to 29 per cent at 21 months, when refractory pain constituted 82 per cent of all unacceptable pain.

The Area Under the Curve (AUC) for VAS was lower with MTX+IFX group, and at 21 months, 32 per cent with MTX+IFX and 45 per cent with MTX+SSZ+HCQ had unacceptable pain (adjusted relative risk 0.68%; 95% CI 0.51-0.90).

Almost one-third of new-onset RA with insufficient response to MTX experienced unacceptable pain at 21 months. Pain indicative of a non-inflammatory mechanism accounted for more than 80 per cent of all unacceptable pain.