{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T22:21:59Z","timestamp":1792707719474,"version":"4.5.0"},"reference-count":45,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,3,19]],"date-time":"2024-03-19T00:00:00Z","timestamp":1710806400000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2024,2,8]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Despite better therapies and strategies, many people with rheumatoid arthritis (RA) have persistent pain, often from abnormal pain processing, now termed nociplastic pain. However, RA patients with fibromyalgia (FM), a central nociplastic pain syndrome, also have power doppler ultrasound (PDUS+) joint inflammation. To understand the complex causes of pain, we performed clinical examination and patient-reported outcome measures (PROMs) plus comprehensive PDUS evaluation not previously combined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In a cross-sectional study of sequential RA patients with at least moderate DAS28 erythrocyte sedimentation rate disease activity, we assessed 66\/68 joints for swelling and tenderness, respectively, FM American College of Rheumatology 2010 diagnostic criteria, completed PROMs for function, quality of life and mood, alongside PDUS examination of 44 joints. Statistical analysis included logistic regression modelling and regularised (lasso) logistic regression methods.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From 158 patients, 72 (46%) patients met FM criteria, with significantly worse tender joint counts and PROMs, but no differences in PDUS compared with the non-FM group. Categorising patients by PDUS+ joint presence and\/or FM criteria, we identified four distinct groups: 43 (27.2%) patients with \u2212FM\u2212PD, 43 (27.2%) with \u2212FM+PD, 42 (26.6%) with +FM\u2212PD and 30 (19%) with +FM+PD. Both FM+ groups had worse PROMs for fatigue, mood and pain, compared with the FM\u2212 groups. We were unable to develop algorithms to identify different groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The unexpected group \u2212FM\u2212PD group may have peripheral nociplastic pain, not commonly recognised in rheumatology. Only 46% of patients demonstrated PDUS+ inflammation. However clinical examination and PROMs did not reliably differentiate groups, emphasising PDUS remains an important tool.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2023-003784","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T02:35:10Z","timestamp":1710902110000},"page":"e003784","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Pain sensitisation and joint inflammation in patients with active rheumatoid arthritis"],"prefix":"10.1136","volume":"10","author":[{"given":"Khaldoun","family":"Chaabo","sequence":"first","affiliation":[{"name":"Rheumatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estee","family":"Chan","sequence":"additional","affiliation":[{"name":"Rheumatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toby","family":"Garrood","sequence":"additional","affiliation":[{"name":"Rheumatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8251-4037","authenticated-orcid":false,"given":"Zoe","family":"Rutter-Locher","sequence":"additional","affiliation":[{"name":"Rheumatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Vincent","sequence":"additional","affiliation":[{"name":"Guy's and St Thomas' Hospitals NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Galloway","sequence":"additional","affiliation":[{"name":"Academic Department of Rheumatology, King's College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1714-9963","authenticated-orcid":false,"given":"Sam","family":"Norton","sequence":"additional","affiliation":[{"name":"Academic Department of Rheumatology, King's College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5110-3320","authenticated-orcid":false,"given":"Bruce W","family":"Kirkham","sequence":"additional","affiliation":[{"name":"Rheumatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,19]]},"reference":[{"key":"2025090313411007000_10.1.e003784.1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(16)30173-8. PubMed PMID: 27156434."},{"key":"2025090313411007000_10.1.e003784.2","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1002\/acr.22824","article-title":"Unraveling patient-preferred health and treatment outcomes in early rheumatoid arthritis: a longitudinal qualitative study","volume":"68","author":"van der Elst","year":"2016","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090313411007000_10.1.e003784.3","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1002\/acr.20151","article-title":"Patient perspective of measuring treatment efficacy: the rheumatoid arthritis patient priorities for pharmacological interventions (RAPP-PI) outcomes","volume":"62","author":"Sanderson","year":"2010","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090313411007000_10.1.e003784.4","doi-asserted-by":"publisher","DOI":"10.1002\/art.10515"},{"key":"2025090313411007000_10.1.e003784.5","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2022.927179","article-title":"Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: systematic review and meta-analysis","volume":"13","author":"de Castro","year":"2022","journal-title":"Front Pharmacol"},{"key":"2025090313411007000_10.1.e003784.6","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223365"},{"key":"2025090313411007000_10.1.e003784.7","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s41927-019-0054-y","article-title":"Real world long-term impact of intensive treatment on disease activity, disability and health-related quality of life in rheumatoid arthritis","volume":"3","author":"Gullick","year":"2019","journal-title":"BMC Rheumatol"},{"key":"2025090313411007000_10.1.e003784.8","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1186\/s13075-016-1186-8","article-title":"Discordant inflammation and pain in early and established rheumatoid arthritis: latent class analysis of early rheumatoid arthritis network and British society for rheumatology biologics register data","volume":"18","author":"McWilliams","year":"2016","journal-title":"Arthritis Res Ther"},{"key":"2025090313411007000_10.1.e003784.9","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2014.64"},{"key":"2025090313411007000_10.1.e003784.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0180014","article-title":"Pain and pain mechanisms in patients with inflammatory arthritis: a danish nationwide cross-sectional DANBIO registry survey","volume":"12","author":"Rifbjerg-Madsen","year":"2017","journal-title":"PLoS One"},{"key":"2025090313411007000_10.1.e003784.11","doi-asserted-by":"crossref","first-page":"105399","DOI":"10.1016\/j.jbspin.2022.105399","article-title":"Assessing central sensitization with quantitative sensory testing in inflammatory rheumatic diseases: a systematic review","volume":"89","author":"Trouvin","year":"2022","journal-title":"Jt Bone Spine"},{"key":"2025090313411007000_10.1.e003784.12","unstructured":"Sofat N , Harrison A , Ahmed S . The utility of the paindetect questionnaire in assessing pain in rheumatoid arthritis. Rheumatology (United Kingdom) 2015;54. Available: http:\/\/ovidsp.ovid.com\/ovidweb.cgi?T=JS&PAGE=reference&D=emed16&NEWS=N&AN=626092293"},{"key":"2025090313411007000_10.1.e003784.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00392-5"},{"key":"2025090313411007000_10.1.e003784.14","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/key075.533"},{"key":"2025090313411007000_10.1.e003784.15","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.138461"},{"key":"2025090313411007000_10.1.e003784.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2016.08.012"},{"key":"2025090313411007000_10.1.e003784.17","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.10245"},{"key":"2025090313411007000_10.1.e003784.18","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780230202"},{"key":"2025090313411007000_10.1.e003784.19","doi-asserted-by":"publisher","DOI":"10.3109\/07853890109002087"},{"key":"2025090313411007000_10.1.e003784.20","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"2025090313411007000_10.1.e003784.21","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"2025090313411007000_10.1.e003784.22","doi-asserted-by":"publisher","DOI":"10.1097\/00006842-200203000-00008"},{"key":"2025090313411007000_10.1.e003784.23","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2016-000428","article-title":"Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce\u2014part 1: definition and development of a standardised, consensus-based scoring system","volume":"3","author":"D\u2019Agostino","year":"2017","journal-title":"RMD Open"},{"key":"2025090313411007000_10.1.e003784.24","first-page":"1976","article-title":"A modified version of Larsen\u2019s scoring method to assess radiologic changes in rheumatoid arthritis","volume":"22","author":"Rau","year":"1995","journal-title":"J Rheumatol"},{"key":"2025090313411007000_10.1.e003784.25","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.rdc.2020.12.008","article-title":"Why it hurts: the mechanisms of pain in rheumatoid arthritis","volume":"47","author":"Iyer","year":"2021","journal-title":"Rheum Dis Clin North Am"},{"key":"2025090313411007000_10.1.e003784.26","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1002\/art.42429","article-title":"The biology of pain: through the rheumatology lens","volume":"75","author":"Sunzini","year":"2023","journal-title":"Arthritis Rheumatol"},{"key":"2025090313411007000_10.1.e003784.27","first-page":"94","article-title":"Pain mechanisms in rheumatoid arthritis","volume":"35 Suppl 107","author":"McWilliams","year":"2017","journal-title":"Clin Exp Rheumatol"},{"key":"2025090313411007000_10.1.e003784.28","doi-asserted-by":"publisher","DOI":"10.1186\/ar3305"},{"key":"2025090313411007000_10.1.e003784.29","doi-asserted-by":"crossref","first-page":"e383","DOI":"10.1016\/S2665-9913(21)00032-1","article-title":"Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine","volume":"3","author":"Nijs","year":"2021","journal-title":"Lancet Rheumatol"},{"key":"2025090313411007000_10.1.e003784.30","doi-asserted-by":"crossref","first-page":"833104","DOI":"10.3389\/fpain.2022.833104","article-title":"The path to discovery of windup and central sensitization","volume":"3","author":"Mendell","year":"2022","journal-title":"Front Pain Res (Lausanne)"},{"key":"2025090313411007000_10.1.e003784.31","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000568"},{"key":"2025090313411007000_10.1.e003784.32","doi-asserted-by":"crossref","first-page":"2881","DOI":"10.1097\/j.pain.0000000000002277","article-title":"Responsiveness of quantitative sensory testing-derived sensory phenotype to disease-modifying intervention in patients with entrapment neuropathy: a longitudinal study","volume":"162","author":"Kennedy","year":"2021","journal-title":"Pain"},{"key":"2025090313411007000_10.1.e003784.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2010.09.030"},{"key":"2025090313411007000_10.1.e003784.34","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s10067-019-04749-1","article-title":"The important role of central sensitization in chronic musculoskeletal pain seen in different rheumatic diseases","volume":"39","author":"Guler","year":"2020","journal-title":"Clin Rheumatol"},{"key":"2025090313411007000_10.1.e003784.35","first-page":"980","article-title":"Central sensitisation features are associated with neuropathic pain-like symptoms in patients with longstanding rheumatoid arthritis: a cross-sectional study using the central sensitisation inventory","volume":"40","author":"Saitou","year":"2022","journal-title":"Clin Exp Rheumatol"},{"key":"2025090313411007000_10.1.e003784.36","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep458"},{"key":"2025090313411007000_10.1.e003784.37","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-016-1258-6","article-title":"Rheumatoid arthritis patients with Fibromyalgic clinical features have significantly less synovitis as defined by power doppler ultrasound","volume":"17","author":"Mian","year":"2016","journal-title":"BMC Musculoskelet Disord"},{"key":"2025090313411007000_10.1.e003784.38","doi-asserted-by":"crossref","first-page":"131","DOI":"10.2174\/1573397111666150619095007","article-title":"Fibromyalgia: the prototypical central sensitivity syndrome","volume":"11","author":"Boomershine","year":"2015","journal-title":"Curr Rheumatol Rev"},{"key":"2025090313411007000_10.1.e003784.39","first-page":"119","article-title":"Fibromyalgia: revisiting the literature","volume":"48","author":"Forbes","year":"2004","journal-title":"J Can Chiropr Assoc"},{"key":"2025090313411007000_10.1.e003784.40","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-015-0525-5"},{"key":"2025090313411007000_10.1.e003784.41","doi-asserted-by":"crossref","DOI":"10.1136\/bmjos-2021-100235","article-title":"Fibroblasts: the neglected cell type in peripheral sensitisation and chronic pain? A review based on a systematic search of the literature","volume":"6","author":"Shinotsuka","year":"2022","journal-title":"BMJ Open Sci"},{"key":"2025090313411007000_10.1.e003784.42","doi-asserted-by":"publisher","DOI":"10.3310\/hta22440"},{"key":"2025090313411007000_10.1.e003784.43","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep171"},{"key":"2025090313411007000_10.1.e003784.44","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1097\/j.pain.0000000000001590","article-title":"Quantitative sensory testing and predicting outcomes for musculoskeletal pain, disability, and negative affect: a systematic review and meta-analysis","volume":"160","author":"Georgopoulos","year":"2019","journal-title":"Pain"},{"key":"2025090313411007000_10.1.e003784.45","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ker399"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2023-003784","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T20:41:22Z","timestamp":1756932082000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2023-003784"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,3,19]]},"published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1136\/rmdopen-2023-003784"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2023-003784","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3]]}}}