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Additional file 1: The bidirectional relationship between chronic joint pain and frailty: data from the Investigating Musculoskeletal Health and Wellbeing cohort.

ObjectivesTo investigate how social support, financial status and lifestyle influence the development of excess disability in rheumatoid arthritis (RA).MethodsData came from the Étude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) cohort study of people with RA. A previous analysis identified groups with similar inflammation trajectories but markedly different disability over 10 years; those in the higher disability trajectory groups were defined as having “excess disability”. Participants self-reported data on contextual factors (social support, financial situation, lifestyle) and completed patient reported outcome measures (PROMs; pain, fatigue, anxiety, depression) at baseline. The direct effect of the contextual factors on excess disability and the effect mediated by PROMs was assessed using structural equation models. Findings were validated within two independent datasets (Norfolk Arthritis Register [NOAR], Early Rheumatoid Arthritis Network [ERAN]).ResultsOf 538 included ESPOIR participants (mean age [standard deviation (SD)]: 48.3 [12.2] years, 79.2% women), 200 (37.2%) were in the excess disability group. Less social support (β 0.17 [95% CI 0.08, 0.26]), worse financial situation (β 0.24 [95% CI 0.14, 0.34]), less exercise (β 0.17 [95% CI 0.09, 0.25]) and less education (β 0.15 [95% CI 0.06, 0.23]) were associated with excess disability group membership; smoking, alcohol consumption and body mass index were not. Fatigue and depression mediated a small proportion of these effects. Similar results were seen in NOAR and ERAN.ConclusionsGreater emphasis is needed on the economic and social context of people with RA at presentation; these factors might influence disability over the following decade.

Background: Glucocorticosteroids (GCs) are recommended to suppress inflammation in people with active RA. This systematic review and meta-analysis aimed to quantify the effects of systemic GCs on RA pain.Methods: A systematic literature review of randomised controlled trials (RCTs) in RA comparing systemic GCs to inactive treatment. Three databases were and spontaneous pain and evoked pain outcomes were extracted. Standardized mean differences (SMDs) and mean differences (MDs) were meta-analysed. Heterogeneity (I², tau statistics) and bias (funnel plot, Eggers test) were assessed. Subgroup analyses investigated sources of variation. This study was pre-registered (PROSPERO CRD42019111562). Results: 18903 titles, 880 abstracts and 226 full texts were assessed. Thirty three RCTs suitable for the meta-analysis included 2658 participants. Pain scores (spontaneous pain) decreased in participants treated with oral GCs; SMD= -0.65 (15 studies, 95% CI, -0.82, -0.49, p3 to 6 months, and -6mm (95% CI, -10mm, -2mm) at >6 months. Similar findings were obtained when evoked pain outcomes were examined. Data from 5 RCTs suggested improvement also in fatigue during GC treatment.Discussion. Oral GCs are analgesic in RA. The benefit is greatest shortly after initiation and GCs might not achieve clinically important pain relief beyond 3 months. Treatments other than anti-inflammatory GCs should be considered to reduce the long-term burden of pain in RA.

OBJECTIVES: Pain is the prevailing symptom of knee osteoarthritis. Central sensitisation creates discordance between pain and joint pathology. We previously reported a central pain mechanisms trait derived from 8 discrete characteristics: neuropathic-like pain, fatigue, cognitive-impact, catastrophising, anxiety, sleep disturbance, depression, and pain distribution. We here validate and show that an 8-item questionnaire, Central Aspects of Pain in the Knee (CAP-Knee) is associated both with sensory and affective components of knee pain severity.METHODS: Participants with knee pain were recruited from the Investigating Musculoskeletal Health and Wellbeing study in the East Midlands, UK. CAP-Knee items were refined following cognitive interviews. Psychometric properties were assessed in 250 participants using Rasch-, and factor-analysis, and Cronbach’s alpha. Intra-class correlation coefficients tested repeatability. Associations between CAP-Knee and McGill Pain questionnaire pain severity scores using linear regression.RESULTS: CAP-Knee targeted the knee pain sample well. Cognitive interviews indicated that participants interpreted CAP-Knee items in diverse ways aligned to their intended meanings. Fit to the Rasch model was optimised by rescoring each item, producing a summated score from 0-16. Internal consistency was acceptable (Cronbach’s alpha=0.74) and test–retest reliability excellent (ICC2,1=0.91). Each CAP-Knee item contributed uniquely to one discrete `Central Mechanisms trait’ factor. High CAP-Knee scores were associated with worse overall knee pain intensity and with each of sensory and affective McGill Pain Questionnaire scores.CONCLUSION: CAP-Knee is a simple and valid self-report questionnaire, which measures a single `Central Mechanisms’ trait, and may help identify and target centrally-acting treatments aiming to reduce the burden of knee pain.

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Additional file 2: Supplement 2. CAP-RA PIS final version 1.218082020. CAP-RA Participant Information Sheet, describing the study protocol to potential participants and members of the public in lay language.

Additional file 1: Supplement 1. SPIRIT Checklist describing protocol items for clinical trials.

Additional file 2.

Additional file 3: Supplement 3. CAP-RA consent form final version 1.423092020 CAP-RA study participant consent form.

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Additional file 2.