Olofsson T, Wallman JK, Joud A, et al. - The results indicated that almost one-third of new-onset rheumatoid arthritis (RA) patients reported unacceptable pain after 21 months, and refractory pain constituted more than 4/5 of this pain load, despite active combination treatment. Both cumulative pain and unacceptable pain were decreased at 21 months by adding infliximab (IFX) vs sulfasalazine (SSZ) plus hydroxychloroquine (HCQ) to methotrexate (MTX), implying less long-term pain for the biologic therapy. These results display insufficient effects of current treatment strategies on inflammation-independent pain components, warranting alternative approaches in affected patients.

• Results showed that 50% of randomized patients (n = 258) in the crude setting reported unacceptable pain at randomization, declining to 29% at 21 months (P < 0.001) when refractory pain constituted 82% of all unacceptable pain.

• Comparing randomized arms (intent-to-treat analysis), for VAS pain, the AUC was lower in the MTX plus IFX group (P = 0.01), and at 21 months, 32% of patients receiving MTX plus IFX and 45% receiving MTX plus SSZ plus HCQ had unacceptable pain (adjusted relative risk 0.68 [95% confidence interval 0.51, 0.90]; P = 0.008).

• There were no between-group differences regarding refractory pain.