Thinking Outside the Joints: The Impact of Nonarticular Pain on Patient‐Reported Outcomes in a Prospective Longitudinal Real‐World Early Rheumatoid Arthritis Cohort
Bibliographic record
Abstract
OBJECTIVE: We aimed to understand the association of nonarticular pain (NAP), regional and widespread, with patient-reported outcomes in early rheumatoid arthritis (RA). METHODS: This real-world, multicenter study observed participants with newly diagnosed active early RA (symptoms <1 year; Clinical Disease Activity Index [CDAI] score >2.8) over the first year. Participants were examined by rheumatologists and synchronously completed body pain diagrams and Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) measures at regular intervals. Participants were classified as follows: (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 participants with early RA were mostly women (66%), had a mean age of 57 (SD 14) years, and had active disease (mean CDAI 27.0 [SD 14.1]). Over one-half (n = 246, 52%) reported NAP at baseline; of these, 72% (176 of 246) had regional NAP, and 28% (70 of 246) had widespread NAP. Adjusted mean change in PROMIS-29 domains were significantly worse in patients with regional versus no NAP: physical function -1.4 (95% confidence interval [CI] -2.1 to -0.7), pain interference 2.7 (95% CI 1.9-3.5), sleep disturbance 1.2 (95% CI 0.4-2.0), fatigue 2.1 (95% CI 1.2-3.1), anxiety 1.5 (95% CI 0.7-2.4), depression 1.4 (95% CI 0.5-2.2), and social participation -2.4 (95% CI -3.3 to -1.5). Associations between widespread and no NAP were larger for pain interference (5.0 [95% CI 3.7-6.4]), fatigue (3.2 [95% CI 1.7-4.8]), and social participation (-5.6 [95% CI -7.2 to -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 early RA. 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.
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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 | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".