OVERLAPPING CHRONIC PAIN

S. Agachi¹, L. Groppa¹, O. Bujor², R. Usatîi², L. Taran², A. Lesnic² | ¹Department of Rheumatology and Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova; ²Clinical Republican Hospital Timofei Mosneaga, Chisinau, Republic of Moldova

Abstract

Background and Aims. Overlapping chronic pain conditions (OCPCs) are increasingly recognized in patients with rheumatic diseases, potentially influencing disease assessment and treatment decisions. To evaluate the prevalence and impact of OCPC in rheumatic patients.
Methods. We conducted an observational study including 150 patients, divided equally into rheumatoid arthritis (RA) (n=50), systemic lupus erythematosus (SLE) (n=50), and systemic sclerosis (SSc) (n=50) groups. OCPCs were identified based on clinical evaluation and patient-reported pain characteristics. Disease activity scores and treatment requirements were compared between patients with and without OCPC.
Results. OCPCs were identified in 36 patients (24%): RA 12/50 (24%), SLE 16/50 (32%), and SSc 8/50 (16%). In RA, fibromyalgia (58.3%) and chronic low back pain (33.3%) predominated. In SLE, fibromyalgia (50%), chronic headache (37.5%), irritable bowel syndrome–related pain (31.3%), and chronic pelvic pain (18.8%) were common, with multiple overlapping conditions frequent. In SSc, musculoskeletal pain (50%), fibromyalgia-like pain (37.5%), and headache (25%) were observed. Patients with OCPC exhibited higher disease activity scores: RA DAS28 5.1 ± 0.8 vs 3.8 ± 0.7, SLE SLEDAI 12.4 ± 3.1 vs 8.6 ± 2.9, and SSc mRSS 18.2 ± 4.5 vs 13.1 ± 3.8. Intensified immunosuppressive therapy was required in 69.4% of patients with OCPC versus 36.0% without.
Conclusions. OCPC are common in rheumatic diseases, linked to higher disease activity and greater therapy needs, highlighting the risk of misattributing pain to inflammation and the need for precise pain phenotyping and multimodal management.