POS1291 PREVALENCE OF PAINFUL AND SWOLLEN JOINTS IN NURSING HOME RESIDENTS WITH AND WITHOUT DEMENTIA: A CROSS-SECTIONAL STUDY

Shennah Austen, Annelies Boonen, Jos M. G. A. Schols, Marloes van Onna

<h2>Abstract</h2><h3>Background:</h3> The proportion of nursing home residents with pain not receiving adequate pain treatment is estimated to be 25% [1]. Musculoskeletal pain originating from rheumatic and musculoskeletal diseases (RMDs) in nursing home residents is often not adequately recognised and as a result undertreated. In a recent systematic literature review, we found that the prevalence for musculoskeletal pain in nursing home residents ranged between 0.9-77%; largely due to substantial heterogeneity in the documentation of RMD symptoms [2]. Pain significantly impacts the daily lives of nursing home residents, often leading to behavioural issues such as agitation, anxiety or resistance to care, as well as limitations in mobility. Early recognition and subsequently tailored treatment of RMDs in nursing homes residents may prevent further loss of independence and improve health-related quality of life. <h3>Objectives:</h3> The primary objective was to assess the prevalence of painful and/or swollen joints in nursing home residents with and without dementia. Secondary objectives included evaluating the current joint pain, as reported by the nursing home resident if possible, and conducting a physician's assessment of overall (joint) health. <h3>Methods:</h3> For this cross-sectional study, participants were recruited from the nursing homes of Cicero Zorggroep, situated in the south of the Netherlands. They were divided into two groups: residents without dementia (group 1) and residents with dementia (group 2). All residents ≥ 65 years and permanently admitted were eligible for inclusion. Nursing home residents with a life expectancy of < two weeks were excluded. Residents with dementia were excluded in case of anticipated resistance to a physical examination. Presence of tender and/or (bony or synovial) swollen joints was determined by an extensive physical examination by a trained elderly care physician, based on the 66/68 joint count method. The assessor evaluated overall (joint) health by using a visual analogue scale (VAS; 0mm=very bad (joint) health, 100mm=excellent (joint) health). Residents in group 1 answered three VAS questions regarding current joint pain, overall pain in the past week and overall health (0mm= no pain/excellent health, 100mm=a lot of pain/very bad health). Group 2 answered one VAS question regarding current joint pain. When the VAS was not possible in group 2, the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC, score ≥4 out of 24 is indicative for pain) was used. <h3>Results:</h3> In total, 100 nursing home residents (mean age 83.3 years (range 70-102) were included (50 residents group 1; 50 residents group 2). Half of the residents (50%) had ≥1 tender joint with a mean number of 1.3 ± 2.4 tender joints. Almost all residents (95%) had ≥1 bony joint swelling with a mean number of 6.2 ± 4.3 bony swollen joints (Table 1). There were no statistically significant differences between both groups for tender or bony swollen joints. Ten percent had ≥1 synovial swollen joint with a mean number of 0.3 ± 0.9 synovial swollen joints (Table 1). There were significantly more synovial swollen joints in group 1 (9 residents versus 1 resident, p<.001). The VAS joint pain scores were significantly higher in group 1 (24.3 ± 35.2mm; n=50) compared to group 2 (12.1 ± 26.1mm; n=21) (p =0.028) (Table 1). In residents with synovial swollen joints the VAS joint pain was higher compared to residents without synovial swollen joints 37.2 ± 22.0mm (n =9) versus 19.6 ± 29.6mm (n =62). The mean PACSLAC was 1.5 ± 1.9 (n =29). Overall health was scored worse in group 1 (mean assessor VAS score: overall health: 48.9mm versus 56.4mm; p=0.003; joint health: 72.9mm versus 56.4mm; p=0.003) (Table 1). <h3>Conclusion:</h3> Tender and swollen joints are highly prevalent among nursing home residents. Synovial swollen joints were more commonly observed in residents without dementia, potentially due to their poorer general health, as complex multimorbidity is often a key factor in their admission to a nursing home. Residents with synovial swollen joints reported higher levels of pain compared to those without synovial swollen joints. It is important to consider the presence of RMDs as a contributing factor to chronic pain and perform a thorough physical examination, as joint complaints in nursing home residents are not always effectively communicated. <h3>REFERENCES:</h3> [1] Boerlage AA, van Dijk M, Stronks DL, et al. Eur J Pain 2008;12:910-916. [2] Austen S, Kamps I, Boonen A, et al. Eur Geriatr Med 2024;15:1245-1258. Table 1Characteristics of the participating nursing home residents.Total group(n =100)Group 1:no dementia(n =50)Group 2:dementia,(n =50)p-valueAge (years, mean ± SD)83.3 ± 5.982.0 ± 6.184.6 ± 5.40.05Woman (n,%)66 (66%)35 (70%)31 (62%)0.40Painful joints (mean ± SD)1.3 ± 2.41.6 ± 3.01.1 ± 1.60.06Bony swelling joints (mean ± SD)6.2 ± 4.36.0 ± 4.46.5 ± 4.30.52Synovial swelling joints (mean ± SD)0.3 ± 0.90.5 ± 1.30.0 ± 0.1<.001VAS current joint pain resident (mean ± SD)^22.2 ± 29.724.3 ± 35.212.1 ± 26.1*0.028VAS overall pain past week resident (mean ± SD)^37.6 ± 35.137.6 ± 35.1NANAVAS overall health past week resident (mean ± SD)^66.6 ± 20.566.6 ± 20.5NANAPACSLAC current pain (mean ± SD)1.5 ± 1.9NA1.5 ± 1.9^⁎⁎NAVAS overall health assessor, (mean ± SD)^^56.4 ± 16.048.8 ± 15.564.0 ± 12.50.07VAS joint health assessor, (mean ± SD)^^64.7 ± 20.456.4 ± 21.372.9 ± 15.80.003*21 residents were able to answer the VAS. **PACSLAC in 29 residents. ^VAS residents=0-100mm; 0mm=no pain/ excellent health, 100mm=a lot of pain/ very bad health. ^^VAS assessor=0-100mm; 0mm=very bad (joint) health, 100mm=excellent (joint) health <h3>Acknowledgements:</h3> Special thanks to Nina Claessen for assistance with data collection. <h3>Disclosure of Interests:</h3> Shennah Austen: None declared, Annelies Boonen Consultancy fees from UCB, Lilly, Novartis, Sandoz and Galapagos, Research grants from Abbvie and Celgene, Jos Schols: None declared, Marloes van Onna Speaker for "Jaar Symposium Reumatologie", Mark Two, Consultancy fees Novartis, Pfizer, Research grant from Pfizer and ReumaNederland. © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.