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03-12-2021 | Rheumatology | News | Article

Targeting pain should be a priority in systemic sclerosis

Author: Claire Barnard

medwireNews: Pain affects almost nine in every 10 people with systemic sclerosis (SSc), with multiple disease-related factors potentially contributing to pain intensity, researchers report.

This study “puts pain back on the agenda for systemic sclerosis,” says Christoph Baerwald (University Hospital, Leipzig, Germany) in a comment accompanying the publication in The Lancet Rheumatology.

He explains that “[a]lthough pain is considered to be a disease key symptom in rheumatoid arthritis,” at present “the focus lies mainly on disease manifestations and comorbidities in systemic sclerosis.”

For the study, Yvonne Lee (Northwestern University Feinberg School of Medicine, Chicago, USA) and co-researchers evaluated the experience of pain in 2157 people with SSc from the Scleroderma Patient-centered Intervention Network cohort. Patients were aged an average of 55 years and 88% were women.

When assessed on an 11-point numeric scale, 87% of participants reported having at least mild pain (≥1 point) over the past week, while 38% said they had experienced moderate or severe pain (≥5 points). The average pain intensity score was 3.6 points.

The team then quantified the interference of pain with patients’ daily functioning by assessing four items (day-to-day activities, work around the home, participation in social activities, and household chores) on a 1–5-point scale, and these scores were combined and converted into a T-score calibrated to the US general population.

In all, 72% of participants experienced pain that interfered with daily functioning (T-score ≥50 points), with 35% having moderate or severe pain interference (T-score ≥60 points).

Baerwal says that these findings “clearly show that pain levels in patients with systemic sclerosis are similar to pain levels reported by patients with rheumatoid arthritis,” with a “considerable” impact on daily life.

Moreover, the study indicates that pain is “a very important patient-reported outcome that should be included in upcoming trials with new disease modifying compounds for systemic sclerosis,” he adds.

Lee et al also identified a diverse range of factors that were significantly associated with pain intensity on multivariable analysis, some of which were manifestations of SSc. These factors included female sex, higher BMI, fewer years in education, joint contractures, digital ulcers, gastrointestinal or skin involvement, and the presence of Sjögren’s syndrome or rheumatoid arthritis.

“Clinically, it is important that patient-centred approaches are taken to understand and to help intervene to reduce the effects of pain in individual patients with systemic sclerosis,” write the researchers.

They add: “Working with patients to identify systemic sclerosis manifestations associated with pain and attempting to address them might be helpful.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

Lancet Rheumatol 2021; 3: e844–854
Lancet Rheumatol 2021; 3: e821–823

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