Expanding the Criteria of the Novel Middle East Pain Syndrome to Include More Rheumatologic and Orthopedic Conditions, Type 2 Diabetes Mellitus, and Advanced Age - Understanding Musculoskeletal Pains among Palestinian Patients with Rheumatoid Arthritis

Author:

AlHabil Yazan1,Koosa Nabil1,Hameedi Seema1,Amer Johnny1,Salhab Ahmad1,Abdalla Mazen A.2,Jaber Mohammad M.2

Affiliation:

1. An-Najah National University

2. An-Najah National University Hospital

Abstract

Abstract

Methods A retrospective study was conducted at three Palestinian healthcare centers between February and December 2023. Targeting RA patients of both sexes and all ages, the clinical characteristics of 397 patients were categorized using a stratified sampling technique. Data were retrieved from each center’s respective archive modalities. An adjusted multiple logistic regression model was utilized to test the association between 1,25(OH)2VD3 and Parathyroid levels with musculoskeletal pain severity. A p-value less than 0.05 was considered statistically significant. The Kolmogorov-Smirnov test was utilized to test the normality of continuous variable distribution. Results Many patients fulfill criteria for other conditions, with slow disease progression noted, despite correct RA diagnosis. Pain severity correlated with deficient 1,25(OH)2VD3 (1.745 OR, P-value:0.05) and high PTH levels (PTH: 1.579 OR, P-value:0.027). Commonly reported pains include lower back, knees, cervical, and upper back areas. Muscular stiffness and bone tenderness are prevalent, with 41.03% reporting severe pain. Increased age correlates with severe pain (OR:1.53, P-value:0.015). Likewise, Type 2 Diabetes mellitus shows a significant positive association (OR:0.741, P-value:0.017). Despite the lack of significant associations, the high prevalence of smoking (47.1%) and hypertension (58.9%) requires intervention. Radiological reporting is unclear in 63.22% of cases, with 'bone spurs' commonly utilized. Additionally, 93.9% have low ionized calcium levels. Other lab results mostly fall within normal ranges, emphasizing the complexity of diagnosis and suggesting the importance of thorough radiological investigations and laboratory assays. Conclusions We recommend expanding MEPS criteria to include other conditions, highlighting the significant associations between 1,25(OH)2VD3 deficiency, HPT, advanced age, and Type 2 Diabetes mellitus with musculoskeletal pains in diagnosed RA cases.

Publisher

Springer Science and Business Media LLC

Reference48 articles.

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3. Secondary and Tertiary Hyperparathyroidism: A Narrative Review;Plas WY;Scand J Surg SJS Off organ Finnish Surg Soc Scand Surg Soc,2020

4. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline;Holick MF;J Clin Endocrinol Metab,2011

5. Pokhrel B, Leslie SW, Levine SN. Primary Hyperparathyroidism. Treasure Island. FL); 2023.

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