THE CORRELATION OF LABELLED WHITE BLOOD CELL STUDIES, PAIN AND INFLAMMATION TO PREDICT JOINT DESTRUCTION IN RHEUMATOlD ARTHRITIS

Abstract

Rheumatoid arthritis (RA) is a chronic polyarticular disease affecting about I% of the adult population of the world. It produces significant joint destruction, physical impairment, work disability and early mortality (Alarcon, 1997; Grossman & Brahan, 1997; Weyand & Goronzy, 1997). Its inflammatory process is targeting the synovial membrane and extra-articular tissues. RA involves principally diarthrodial joints in a characteristic symmetric and additive pattern, and it is not a homogenous disorder. Some patients do exceptionally well, having little or no evidence of joint damage years after onset of the disease. Other patients develop severe joint destruction despite what appears to be an adequate treatment program. The most serious consequences are significant levels of pain, functional disability and extra-articular manifestations such as pulmonary and renal damage (Weyand & Goronzy, 1997). Pain is the most significant symptom in patients with RA and is most closely related to medication use (Kazis et al., 1983). However, the precise relationship between pain and inflammation has not been defined. Previous preliminary studies in non depressed or distressed patients with RA showed a good correlation between pain and inflammation (Peck et al., 1989; Scott et al., 1992). However, the effect of mood and pain coping was not addressed. Previous studies of the patients with chronic pain underlined the poor relationship between tissue damage and pain (Jones & Derbyshire, 1997). Adaptive cognitive and psychological responses are increasingly being recognised as having a pivotal role in the development of impairment, disability and handicap (Anderson et al., 1985; van der Heide et al., 1994; Escalante & Del Rincon, 1999). The severity of depressive symptoms predicted the number and severity of the pain complaints (Doan & Wadden, 1989). Anxiety about pain directs attention to pain which leads to stronger pain responses (Arntz et al., 1991 ). Patients who report using passive or escapist coping have higher levels of pain and more negative mood. Those who report using more active cognitive and behavioural strategies and feel more in control of their pain have lower levels of pain (Keefe et al., 1997).

Neutrophil migration into synovial fluid is a consistent component of inflammatory arthritis (Uno et al., 1986).