Pain in Rheumatoid Arthritis: Seven-Year Follow-Up Study of Pain Distribution and Transitions From and To Chronic Widespread Pain

Jul 8, 2026

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Seven-year follow-up evidence from a longitudinal cohort investigates transitions from and to chronic widespread pain (CWP) in patients with rheumatoid arthritis (RA). Two postal surveys in 2010 and 2017 assessed pain burden, joint findings, functional disability, health-related quality of life, pharmacological treatment, lifestyle factors, and patient-reported BMI. Among 953 participants, CWP prevalence declined while some patients transitioned in both directions. Multivariate analyses linked CWP transitions with modifiable factors, informing pain-focused management beyond inflammation control.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

Objective

Method

Participants and design

Results

Conclusion

Background and rationale

Aim

Pain in rheumatoid arthritis: a seven-year follow-up study of pain distribution and factors associated with transition from and to chronic widespread pain MLE Andersson1,2, B Svensson1, S Bergman1,2,3 1Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden 2Spenshult Research and Development Centre, Halmstad, Sweden 3 Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Objective: To study transitions from and to chronic widespread pain (CWP) over 7 years in patients with rheumatoid arthritis (RA) . Method: Two postal questionnaires were sent to patients included in the BARFOT (Better Anti-Rheumatic Pharmacotherapy) study, the first in 2010 and the second in 2017. The questionnaires assessed pain, number of tender and swollen joints, functional disability, health-related quality of life (HRQoL), pharmacological treatment, lifestyle factors, and patient-reported body mass index (BMI) . The responders to both questionnaires were divided into three groups according to the reported pain duration and distribution: patients having no chronic pain (NCP), chronic regional pain (CRP), and CWP. Results: In all, 953 patients answered the questionnaires at both time-points. One-third (324) of the patients reported CWP in 2010, and 140 (43%) of the patients had transition to NCP or CRP in 2017. In multivariate logistic regression models, adjusting for age, gender, and disease duration, transition from CWP was associated with normal BMI, fewer tender joints, less pain, less fatigue, fewer pain regions, less disability, better HRQoL, and biologic treatment. In 2010, 628 patients reported NCP or CRP, whereas 114 of them reported CWP in 2017. Transition to CWP was associated with female gender, obesity, more tender and swollen joints, higher pain-related variables, worse disability, and worse HRQoL. Conclusion: There are modifiable factors associated with transitions from and to CWP that could be identified. Paying attention to these factors could improve pain treatment in the management of RA. Rheumatoid arthritis (RA) is an inflammatory disease affecting 0.5–1% of the general population (1–3) . Pain is a common symptom in RA and affects daily life functions and health-related quality of life (HRQoL) (4) . Patients with RA rate improvement in pain as oneof the most important effects of treatment (4, 5) . Remaining pain has been reported in 29% of patients with RA and a good European League Against Rheumatism (EULAR) response, and in 70% of those with moderate response (6) . In another study, 30% of the patients reported unacceptable pain despite low inflammation and optimal rheumatic treatment (7) . Pain is a multidimensional experience, associated with physical, psychological, and social aspects of life. Before the diagnosis of RA, factors as genetics, comorbidities (e.g. MLE Andersson, Spenshult R and D Centre, Bäckagårdsvägen 47, SE-302 74 Halmstad, Sweden. [E-mail: maria.andersson@fou-spenshult.se](E-mail: maria.andersson@fou-spenshult.se) Accepted 14 June 2021 fibromyalgia), and depression could already increase the risk of altered pain processing (8) . Pain in early RA could thus be more complex and not only nociceptive due to inflammation. Inflammation can result in changes in pain processing with peripheral and central sensitization as part of nociplastic pain (9–11) . In later stages of RA, structural changes in the joints could also contribute to pain (8) . Changes in pain processing may result in chronic widespread pain (CWP) (8) . A previous study from the cohort used in this paper found that CWP affected one-third of the patients with RA (12) . Other studies have reported concomitant fibromyalgia in about 17–25% of patients with RA (13, 14) . Patients with RA and concomitant CWP and/or fibromyalgia have higher disease activity, more disability

FAQs

What was the main objective of the seven-year study in rheumatoid arthritis patients?

To examine transitions from and to chronic widespread pain (CWP) over a 7-year period in patients with rheumatoid arthritis and to identify associated factors.

How were participants assessed across 2010 and 2017?

Two postal questionnaires collected data on pain, number of tender and swollen joints, functional disability, health-related quality of life, pharmacological treatment, lifestyle factors, and patient-reported BMI.

Which factors were associated with transitioning from CWP in the multivariate analysis?

Transition from CWP was associated with normal BMI, fewer tender joints, less pain and fatigue, fewer pain regions, less disability, better health-related quality of life, and biologic treatment.

Which factors were associated with transition to CWP?

Transition to CWP was associated with female gender, obesity, more tender and swollen joints, higher pain-related variables, worse disability, and worse health-related quality of life.

Jul 8, 2026

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