gms | German Medical Science

Introduction: A remarkable number of patients with rheumatoid arthritis (RA)report persisting pain despite adequate response to anti-inflammatory treatment. Pain perception for these patients may not only result from inflammatory origin, but also from non-inflammatory, e.g. neuropathic, mechanisms and thus compromise anti-inflammatory treatment success [1], [2].

Objectives: To identify patients with persisting pain despite adequate reduction of disease activity, to identify risk factors for persisting pain, and to explore effectiveness of additional pain management for those patients.

Methods: Inclusion criteria of the PAIN-CONTROL study, a prospective, non-interventional, multicenter study in German rheumatology centers are as follows: Fulfillment of 2010 ACR/EULAR classification criteria, disease duration < 8 years, DAS28 ≥ 3.2, SJC ≥ 3, CRP above reference range and pain rating ≥ 50 (VAS, 0-100). Eligible patients have to be escalated in anti-inflammatory treatment and will be divided into subgroups at week 24: 1) reference group: DAS28 improvement > 1.2 or DAS28 ≤ 3.2, VAS pain < 50, 2) non-responder group: DAS28 improvement ≤ 1.2 or DAS28 > 3.2 with or without alleviation of pain, and 3) persisting pain group: DAS28 improvement > 1.2 or DAS28 ≤ 3.2, VAS pain ≥ 50.

For groups 1 and 2 observation of patients will stop at week 24, subjects with persisting pain are followed-up until week 48. At each study visit (weeks 0, 12, 24, 48) demographic data, data on pain, data on anti-rheumatic treatment, DAS28, VAS general health, Rheumatoid Arthritis Impact of Disease (RAID), Health Assessment Questionnaires – Disability Index (HAQ-DI), Patient Health Questionnaire 9 (PHQ-9) and neuropathic pain (painDETECT) are collected. Research endpoints will be proportion of patients with persisting pain despite DAS28 treatment response, predictive effect of clinical parameters and patient-reported outcomes for persisting pain, and an exploratory evaluation of adjunctive pain management.

Results: As of October 2019, a total of N = 414 subjects has been included and N = 51 (12%) subjects with persistent pain could be completely documented after 48 weeks.

Conclusion: The PAIN-CONTROL study is to investigate the prevalence of persisting pain and to understand its risk factors in patients with RA; neuropathic pain might play a key role.

Disclosures: CGB, and RB received speaker or consulting fees from AbbVie. ES, and SG are employees of AbbVie and may own AbbVie stock. AbbVie sponsored this study and contributed to the design, study conduct, and analysis. AbbVie participated in the interpretation of data, review, and approval of the abstract. All authors had access to all relevant data.