Assessment of pain types in recently diagnosed patients with inflammatory arthritis
Bibliographic record
Abstract
Abstract Objective Up to 40% of patients with inflammatory arthritis (IA) experience persistent pain, traditionally thought to be associated with a shift from peripheral to centrally mediated pain during the disease course in some patients. We assessed sensory profiles of recently diagnosed individuals with IA, hypothesising that pain reported at this early stage of diagnosis is driven predominantly by peripheral joint inflammation. Methods Recently diagnosed IA patients with pain numerical rating scale (NRS) scores of ≥3 were recruited. We collected data on: Arthritis activity (Disease Activity Score-28 (DAS-28), musculoskeletal ultrasound); quality of life (Musculoskeletal Health questionnaire (MSK-HQ), Euro Quality of Life questionnaire (EQ-5D)); mental health status (Patient Health Questionnaire Anxiety, Depression Scale (PHQ-ADS)), and pain characteristics (fibromyalgia criteria, painDETECT, Static and Dynamic Quantitative Sensory Testing, QST). Results 61 participants (57% female, 62% rheumatoid arthritis) were enrolled: mean age 49.8 ±15; time since diagnosis 1.2±2.3 months. 97% had peripheral joint inflammation, with a mean DAS-28 score of 3.8±1. However, 20% had a tender minus swollen joint count of ≥7, 21% met the fibromyalgia criteria and 25% had a painDETECT score of ≥19, which significantly correlated with DAS28, MSK-HQ and PHQ-ADS scores. QST revealed lowered pressure pain thresholds at non-articular sites in a subset of participants and facilitated temporal pain summation and deficient pain modulation in 18% and 61% of patients respectively. Conclusion This study provides evidence of centrally mediated pain at the time of diagnosis, challenging the notion that, even at the early stage of disease, pain is driven only by peripheral mechanisms. SIGNIFICANCE AND INNOVATIONS This study is the first to record comprehensive sensory profiles incorporating clinical examination, ultrasound, questionnaire, and quantitative sensory testing data in the early stage of inflammatory arthritis diagnosis. Of those tested, 97% had peripheral joint inflammation confirmed by clinical assessment and ultrasound. In addition, clinical, patient-reported and QST outcome measures revealed the likely presence of centrally mediated pain in a subset of participants. These findings challenge the current belief that only peripheral mechanisms driven by joint inflammation underpin pain in the early stage of disease progression, highlighting a role for centrally mediated pain even in the early stage of disease.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".