title: Differences in pain and fatigue perception among a group of rheumatoid arthritis patients in the United States and in Turkey who have similar disease activity and functional status.
abstract: OBJECTIVE
  The concordance of patient reported outcomes in rheumatoid arthritis (RA) among different countries has not been studied in detail. We tried to determine the differences in pain and fatigue perception among a group of RA patients in the US and in Turkey who had similar disease activity and functional score in multidimensional health assessment questionnaire (MDHAQ FN).
  
  
  METHODS
  One hundred and thirty seven RA patients from Turkey and 129 from the US were studied. An MDHAQ was obtained and a DAS28 was calculated for each patient. Pain and fatigue perception was compared between the two groups after adjusting for age, sex, MDHAQ FN and DAS 28.
  
  
  RESULTS
  Turkish patients had less pain than their US counterparts when adjusted for MDHAQ FN, DAS 28, age and sex (3.56 (2.24) vs. 4.35 (2.23), p=0.005) whereas there was no difference in fatigue between the two groups (3.85 (2.44) vs. 4.25 (2.45), p=0.194). When the patients with a DAS28 score of above 5.1 and below 2.6 were compared in both groups, Turkish patients had again less pain albeit less in the high disease activity group.
  
  
  CONCLUSIONS
  This study suggests that Turkish patients have less pain than the US patients when controlled for age, gender and MDHAQFN and DAS28 scores. This is at odds to the conventional wisdom that pain perception is increased among the non-Western cultures.
authors.affiliation: Department of Rheumatology, Bakirköy Dr. Sadi Konuk Research and Teaching Hospital, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Celik
authors.forename: I
authors.initials: I
authors.lastname: Fresko
authors.forename: N
authors.initials: N
authors.lastname: Sut
authors.forename: N M
authors.initials: NM
authors.lastname: Batumlu
authors.forename: H
authors.initials: H
authors.lastname: Yazici
authors.forename: Y
authors.initials: Y
authors.lastname: Yazici
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000503:physiopathology*; D004185:Disability Evaluation; D005221:Fatigue / Q000503:physiopathology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D058748:Pain Perception / Q000502:physiology*; D012720:Severity of Illness Index; D014421:Turkey; D014481:United States