TOPLINE

Many patients newly diagnosed with rheumatoid arthritis (RA) experienced unacceptable pain after 2 years despite having low levels of inflammation, and this was especially seen in female patients and those with higher baseline pain or a higher number of tender than swollen joints.

METHODOLOGY

• Researchers analyzed records of Swedish patients first diagnosed with RA between 2012 and 2020 who had symptoms for less than 1 year to identify predictors of unacceptable pain.
• The analysis included 10,297 patients with a mean age of approximately 60 years, and nearly two thirds were women. The median duration of symptoms was 4 months.
• Pain was measured using a 0-100 mm visual analog scale (VAS), and unacceptable pain was defined as a VAS score > 40 mm.
• A low level of inflammation was defined as C-reactive protein (CRP) levels < 10 mg/L. The researchers also used a stricter definition that additionally required a swollen joint count of ≤ 1 out of 28 joints.

TAKEAWAY

• Among patients with 2-year follow-up data, 33.3% had unacceptable pain at 2 years, and 25.6% met this threshold despite having low levels of inflammation.
• Female patients had 37% and 43% increased odds of unacceptable pain at 1 year and 2 years, respectively (P < .001 for both). Female patients with low levels of inflammation had 44% and 56% increased odds of unacceptable pain at 1 year and 2 years, respectively (P < .001 for both).
• Lower baseline levels of CRP were associated with smaller reductions in VAS pain over 2 years and with higher odds of unacceptable pain despite low inflammation (P < .05 for both).
• Higher baseline scores for pain and a tender-swollen joint difference of ≥ 7 were associated with greater odds of unacceptable pain at follow‑up (P < .05 for both).

IN PRACTICE

“Given [the] results, the assessment of [tender-swollen joint difference] in early RA may be useful for identifying patients in need of extended observation and management due to a higher risk for development of long-lasting pain,” the authors wrote.

SOURCE

The study was led by Anna Eberhard, MD, Lund University, Malmö, Sweden. It was published online on June 19, 2026, in Annals of the Rheumatic Diseases.

LIMITATIONS

The study was observational, and the 1- and 2-year visit data were missing for many patients. Researchers used only the VAS pain scale and could not describe different kinds or locations of pain. Data on pain medication were not available.

DISCLOSURES

The study received support from the Swedish Research Council, the Swedish Rheumatism Association, and Lund University. Several authors reported receiving consulting fees and speaking fees and/or having research agreements with multiple pharmaceutical companies. One author is an employee of UCB Pharma. Detailed disclosures are available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.