Back pain in patients with rheumatoid arthritis (based on long-term prospective observation)

Back pain (BP) is less common in patients with rheumatoid arthritis (RA) than in the general population. However, RA patients who do experience BP tend to have lower functional activity scores, lower general health assessments, and higher overall pain intensity. The development of osteoporosis (OP) is considered a risk factor for vertebral fractures and possibly for BP.

Objective: to identify factors influencing the onset and persistence of pain in the thoracic and lumbar spine in RA patients under long-term prospective observation.

Material and methods. This prospective, non-interventional cohort study included 151 women with RA. The mean patient age was 53.9±9.2 years; the average age at onset of BP was 53.6±12.2 years, and at RA diagnosis – 41.9±12.5 years. The average follow-up duration was 9.7±1.7 years. All patients underwent clinical, laboratory, and radiological assessments at baseline and during follow-up, including spinal radiomorphometry according to Genant, X-ray densitometry of the lumbar spine (LI–LIV), and femoral neck. Pain was assessed using the visual analogue scale (VAS).

Results and discussion. During the follow-up, the number of women with BP increased from 96 (63%) to 116 (77%), and those with lumbar pain from 77 (51%) to 101 (67%). VAS pain intensity in the thoracic spine averaged 49±18 mm at baseline and 51±16 mm at follow-up; in the lumbar spine, 47±21 mm and 51±19 mm, respectively. Pain in the thoracic spine appeared or worsened in 31 (20%) cases; in the lumbar spine, in 65 (43%). At baseline, 23 patients (62%) reported severe thoracic pain (>40 mm), and 56 (73%) reported lumbar pain; by the end of the study, these figures were 26 (60%) and 78 (77%), respectively.

Conclusion. Severe thoracic BP (>40 mm) was associated with RA activity, while lumbar pain was linked to age, daily glucocorticoid dose, DAS28 index, HAQ index, and degenerative changes in LII–LIII, LIII–LIV, and LIV–LV. No significant association was found between BP and vertebral deformities, prior peripheral fractures, bone mineral density in LI–LIV or the proximal femur, or T-scores below <-2,5.

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