Thinking Outside the Joints: The Impact of Non‐Articular Pain on Patient Reported Outcomes in a Prospective Longitudinal Real‐World Early RA Cohort

Objective We aimed to understand the association of non‐articular pain(NAP), regional and widespread, with patient‐reported outcomes in early RA(eRA). Methods This real‐world, multi‐center study followed participants with newly diagnosed active eRA (symptoms2.8) over the first year. Participants were examined by rheumatologists and synchronously completed body pain diagrams and Patient Reported Outcomes Measurement Information System(PROMIS)29® measures at regular intervals. Participants were classified as: 1) no NAP 2) regional NAP or 3) widespread NAP. Associations between repeated measures of NAP and PROMIS‐29 over the first year were estimated in separate mixed models, adjusting for sociodemographic and RA characteristics and time‐varying CDAI. Results These 472 eRA participants were mostly women(66%), with mean(SD) age 57(14) and had active disease(mean(SD) CDAI 27.0(14.1)). Over half (n=246, 52%) reported NAP at baseline; of these, 72%(176/246) had regional and 28%(70/246) had widespread NAP. Adjusted mean‐ changes95%CI in PROMIS29 domains were significantly worse in patients with regional vs no NAP: physical function ‐1.4‐2.1, ‐0.7, pain interference 2.71.9, 3.5, sleep disturbance 1.2 0.4, 2.0, fatigue 2.11.2, 3.1, anxiety 1.50.7, 2.4, depression 1.40.5, 2.2 and social participation ‐2.4‐3.3, ‐1.5. Associations between widespread vs no NAP were larger for pain interference 5.03.7, 6.4, fatigue 3.2(1.7, 4.8) and social participation ‐5.6‐7.2, ‐4.0. Mean physical function, pain interference and social participation scores were well outside the normal range. Conclusion NAP interferes with key aspects of well‐being in eRA. Individuals with NAP experience greater pain interference and impairments in physical and social function, supporting a need for earlier identification of and interventions targeting NAP.