Pain in rheumatoid arthritis: a critical review

Abstract

Patients with rheumatoid arthritis (RA) are frequently afflicted by pain, which may be caused by joint inflammation (leading to structural joint damage) or secondary osteoarthritis, and may be increased by central sensitisation. Non-inflammatory pain may also confuse the assessment of disease activity, and so the aim of treatment is not only to combat inflammatory disease, but also relieve painful symptoms. In order to ensure effective treatment stratification, it is necessary to record a patients medical history in detail, perform a physical examination, and objectively assess synovitis and joint damage. The management of pain requires various approaches that include pharmacological analgesia and biological and non-biological treatments. Although joint replacement surgery can significantly improve RA-related pain, it may only be available to patients with the most severe advanced disease.

Pain in systemic inflammatory rheumatic diseases

“…Inflammatory pain symptoms can be partially relieved by non-steroidal anti-inflammatory drugs (NSAIDs) or biological and non-biological disease-modifying anti-rheumatic drugs (DMARDs), but many patients continue to experience moderate pain due to alterations in central pain regulation mechanisms, as in the case of the chronic widespread pain (CWP) characterising fibromyalgia (FM) [3,4]. Non-inflammatory pain may also confuse the assessment of disease activity, and so treatment should be aimed at relieving painful symptoms as well as combating inflammatory disease.…”

“…The importance of distinguishing between central and inflammatory pain in patients with RA or SpA is underlined by the fact that these diseases are currently treated with expensive drugs such as tumour necrosis factor (TNF) inhibitors or other biological agents, and direct costs are higher in patients with concomitant CWP than in those without [3,4]. Optimal RA and SpA treatment must take into account symptoms such as CWP and the overall quality of life, and it requires a combination approach that includes pharmacological analgesia, and the use of biological and non-biological treatments because, although joint replacement surgery can significantly improve RA-related pain, it may only be available to patients with the most severe advanced disease [4].…”

Enhancement of CCL2 expression and monocyte migration by CCN1 in osteoblasts through inhibiting miR-518a-5p: implication of rheumatoid arthritis therapy

“…Pathological features of RA include inflammation, synovial swelling, pannus formation, stiffness in the joints and articular cartilage destruction 3, 4 . Most RA research has focused on cartilage destruction and synovial membrane inflammation.…”

CCN1 Promotes VEGF Production in Osteoblasts and Induces Endothelial Progenitor Cell Angiogenesis by Inhibiting miR-126 Expression in Rheumatoid Arthritis

“…(1,2) Pathological features of RA include inflammation, synovial swelling, pannus formation, stiffness in the joints, and articular cartilage destruction. (3,4) Most RA research has focused on cartilage destruction and synovial membrane inflammation. Less attention has been given to the involvement of subchondral bone erosions in RA pathogenesis.…”