Skip to main content

Advertisement

SpringerLink
Log in

Chronic Pain in Patients with Rheumatoid Arthritis

  • Neuropathic Pain (A Abd-Elsayed, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Chronic pain is highly prevalent in patients with rheumatoid arthritis (RA) and can cause various physical and psychological impairments. Unfortunately, the appropriate diagnosis of chronic pain syndromes in this population can be challenging because pain may be primary to RA-specific inflammation and/or secondary to other conditions, typically osteoarthritis (OA) and fibromyalgia (FM). This disparity further poses a clinical challenge, given that chronic pain can often be discordant or undetected with standard RA-specific surveillance strategies, including serological markers and imaging studies. In this review, we provide a robust exploration of chronic pain in the RA population with emphasis on epidemiology, mechanisms, and management strategies.

Recent Findings

Chronic pain associated with RA typically occurs in patients with anxiety, female sex, and elevated inflammatory status. Up to 50% of these patients are thought to have chronic pain despite appropriate inflammatory suppression, typically due to peripheral and central sensitization as well as secondary OA and FM. In addition to the standard-of-care management for OA and FM, patients with RA and chronic pain benefit from behavioral and psychological treatment options. Moreover, early and multimodal therapies, including non-pharmacological, pharmacological, interventional, and surgical strategies, exist, albeit with varying efficacy, to help suppress inflammation, provide necessary analgesia, and optimize functional outcomes.

Summary

Overall, chronic pain in RA is a difficult entity for both patients and providers. Early diagnosis, improved understanding of its mechanisms, and initiation of early, targeted approaches to pain control may help to improve outcomes in this population

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Aletaha D, Smolen JS. Diagnosis and management of rheumatoid arthritis: a review. JAMA. 2018;320:1360–72. https://doi.org/10.1001/jama.2018.13103.

    Article  PubMed  Google Scholar 

  2. Cao Y, Fan D, Yin Y. Pain mechanism in rheumatoid arthritis: from cytokines to central sensitization. Mediat Inflamm. 2020;2020:1–11. https://doi.org/10.1155/2020/2076328.

    Article  CAS  Google Scholar 

  3. Sarzi-Puttini P, Salaffi F, Di Franco M, Bazzichi L, Cassisi G, Casale R, et al. Pain in rheumatoid arthritis: a critical review. Reumatismo. 2014;66:18–27. https://doi.org/10.4081/reumatismo.2014.760.

    Article  CAS  PubMed  Google Scholar 

  4. Guimarães MFBR, Pinto MRDC, Resende GG, et al. Discordance between the patient’s and physician’s global assessment in rheumatoid arthritis: data from the REAL study-Brazil. PLoS One. 2020;15:e0230317. https://doi.org/10.1371/journal.pone.0230317.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Boers M, van Riel PL, Felson DT, Tugwell P. Assessing the activity of rheumatoid arthritis. Baillieres Clin Rheumatol. 1995;9:305–17. https://doi.org/10.1016/s0950-3579(05)80192-x.

    Article  CAS  PubMed  Google Scholar 

  6. Heiberg T, Kvien TK. Preferences for improved health examined in 1,024 patients with rheumatoid arthritis: pain has highest priority. Arthritis Rheum. 2002;47:391–7. https://doi.org/10.1002/art.10515.

    Article  PubMed  Google Scholar 

  7. Al Attia HM, Al AM. Sensing the main health concerns in patients with established rheumatoid arthritis. Clin Rheumatol. 2011. https://doi.org/10.1007/s10067-011-1853-8.

  8. Odegård S, Finset A, Mowinckel P, Kvien TK, Uhlig T. Pain and psychological health status over a 10-year period in patients with recent onset rheumatoid arthritis. Ann Rheum Dis. 2007;66:1195–201. https://doi.org/10.1136/ard.2006.064287.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chancay MG, Guendsechadze SN, Blanco I. Types of pain and their psychosocial impact in women with rheumatoid arthritis. Womens Midlife Health. 2019;5:3. https://doi.org/10.1186/s40695-019-0047-4.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Walsh DA, McWilliams DF. Pain in rheumatoid arthritis. Curr Pain Headache Rep. 2012;16:509–17. https://doi.org/10.1007/s11916-012-0303-x.

    Article  PubMed  Google Scholar 

  11. McWilliams DF, Walsh DA. Pain mechanisms in rheumatoid arthritis. Clin Exp Rheumatol. 2017;107(5):94–101.

    Google Scholar 

  12. Figueiredo CP, Simon D, Englbrecht M, Haschka J, Kleyer A, Bayat S, et al. Quantification and impact of secondary osteoarthritis in patients with anti-citrullinated protein antibody-positive rheumatoid arthritis. Arthritis Rheum. 2016;68:2114–21. https://doi.org/10.1002/art.39698.

    Article  CAS  Google Scholar 

  13. Basu N, Kaplan CM, Ichesco E, Larkin T, Harris RE, Murray A, et al. Neurobiologic features of fibromyalgia are also present among rheumatoid arthritis patients. Arthritis Rheum. 2018;70:1000–7. https://doi.org/10.1002/art.40451.

    Article  Google Scholar 

  14. Wolfe F, Häuser W, Hassett AL, Katz RS, Walitt BT. The development of fibromyalgia–I: examination of rates and predictors in patients with rheumatoid arthritis (RA). Pain. 2011;152:291–9. https://doi.org/10.1016/j.pain.2010.09.027.

    Article  PubMed  Google Scholar 

  15. Joharatnam N, McWilliams DF, Wilson D, Wheeler M, Pande I, Walsh DA. A cross-sectional study of pain sensitivity, disease-activity assessment, mental health, and fibromyalgia status in rheumatoid arthritis. Arthritis research & therapy. 2015;17:11. https://doi.org/10.1186/s13075-015-0525-5.

    Article  CAS  Google Scholar 

  16. Ten Klooster PM, de Graaf N, Vonkeman HE. Association between pain phenotype and disease activity in rheumatoid arthritis patients: a non-interventional, longitudinal cohort study. Arthritis Res Ther. 2019;21:257. https://doi.org/10.1186/s13075-019-2042-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Martins Rocha T, Pimenta S, Bernardo A, Bernardes M, Barbosa M, Lucas R, et al. Determinants of non-nociceptive pain in rheumatoid arthritis. Acta Reumatol Port. 2018;43(4):291–303.

    PubMed  Google Scholar 

  18. Lee YC, Cui J, Lu B, Frits ML, Iannaccone CK, Shadick NA, et al. Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: a longitudinal observational study. Arthritis Res Ther. 2011;13:R83. https://doi.org/10.1186/ar3353.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hammer HB, Uhlig T, Kvien TK, Lampa J. Pain catastrophizing, subjective outcomes, and inflammatory assessments including ultrasound: results from a longitudinal study of rheumatoid arthritis patients. Arthritis Care Res. 2018;70:703–12. https://doi.org/10.1002/acr.23339.

    Article  Google Scholar 

  20. Walsh DA, McWilliams DF. Mechanisms, impact and management of pain in rheumatoid arthritis. Nat Rev Rheumatol. 2014;10:581–92. https://doi.org/10.1038/nrrheum.2014.64.

    Article  CAS  PubMed  Google Scholar 

  21. England BR, Tiong BK, Bergman MJ, Curtis JR, Kazi S, Mikuls TR, et al. 2019 Update of the American College of Rheumatology recommended rheumatoid arthritis disease activity measures. Arthritis Care Res. 2019;71:1540–55. https://doi.org/10.1002/acr.24042.

    Article  Google Scholar 

  22. Anderson J, Caplan L, Yazdany J, Robbins ML, Neogi T, Michaud K, et al. Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res. 2012;64:640–7. https://doi.org/10.1002/acr.21649.

    Article  Google Scholar 

  23. Aletaha D, Martinez-Avila J, Kvien TK, Smolen JS. Definition of treatment response in rheumatoid arthritis based on the simplified and the clinical disease activity index. Ann Rheum Dis. 2012;71:1190–6. https://doi.org/10.1136/annrheumdis-2012-201491.

    Article  PubMed  Google Scholar 

  24. Li L, Zhang Y, Ma L, Ji P, Yim S, Chowdhury B, et al. Exposure-response modeling and power analysis of components of ACR response criteria in rheumatoid arthritis (part 1: binary model). J Clin Pharmacol. 2017;57:1097–106. https://doi.org/10.1002/jcph.891.

    Article  CAS  PubMed  Google Scholar 

  25. Pratt AG, Isaacs JD. Seronegative rheumatoid arthritis: pathogenetic and therapeutic aspects. Best Pract Res Clin Rheumatol. 2014;28:651–9. https://doi.org/10.1016/j.berh.2014.10.016.

    Article  PubMed  Google Scholar 

  26. Machold KP, Stamm TA, Nell VPK, Pflugbeil S, Aletaha D, Steiner G, et al. Very recent onset rheumatoid arthritis: clinical and serological patient characteristics associated with radiographic progression over the first years of disease. Rheumatology. 2007;46:342–9. https://doi.org/10.1093/rheumatology/kel237.

    Article  CAS  PubMed  Google Scholar 

  27. Wigerblad G, Bas DB, Fernades-Cerqueira C, Krishnamurthy A, Nandakumar KS, Rogoz K, et al. Autoantibodies to citrullinated proteins induce joint pain independent of inflammation via a chemokine-dependent mechanism. Ann Rheum Dis. 2016;75:730–8. https://doi.org/10.1136/annrheumdis-2015-208094.

    Article  CAS  PubMed  Google Scholar 

  28. Doss J, Mo H, Carroll RJ, Crofford LJ, Denny JC. Phenome-wide association study of rheumatoid arthritis subgroups identifies association between seronegative disease and fibromyalgia. Arthritis Rheum. 2017;69:291–300. https://doi.org/10.1002/art.39851.

    Article  CAS  Google Scholar 

  29. Lee YC, Lu B, Boire G, Haraoui BP, Hitchon CA, Pope JE, et al. Incidence and predictors of secondary fibromyalgia in an early arthritis cohort. Ann Rheum Dis. 2013;72:949–54. https://doi.org/10.1136/annrheumdis-2012-201506.

    Article  PubMed  Google Scholar 

  30. Wolfe F, Walitt B. No association of fibromyalgia and seronegative rheumatoid arthritis-the need for uniform application of fibromyalgia criteria in research studies: comment on the article by Doss et al. Arthritis Rheum. 2017;69:679–80. https://doi.org/10.1002/art.39998.

    Article  Google Scholar 

  31. Häuser W, Ablin J, Fitzcharles MA, Littlejohn G, Luciano JV, Usui C, et al. Fibromyalgia. Nat Rev Dis Primers. 2015;1. https://doi.org/10.1038/nrdp.2015.22.

  32. Sinusas K. Osteoarthritis: diagnosis and treatment. Am Fam Physician. 2012;85(1):49–56.

    PubMed  Google Scholar 

  33. Rifbjerg-Madsen S, Wæhrens EE, Danneskiold-Samsøe B, Amris K. Psychometric properties of the painDETECT questionnaire in rheumatoid arthritis, psoriatic arthritis and spondyloarthritis: Rasch analysis and test-retest reliability. Health Qual Life Outcomes. 2017;15:110. https://doi.org/10.1186/s12955-017-0681-1.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ito S, Kobayashi D, Murasawa A, Narita I, Nakazono K. An analysis of the neuropathic pain components in rheumatoid arthritis patients. Intern Med. 2018;57:479–85. https://doi.org/10.2169/internalmedicine.9235-17.

    Article  PubMed  Google Scholar 

  35. Vyas S, Bhalla AS, Ranjan P, Kumar S, Kumar U, Gupta AK. Rheumatoid arthritis revisited - advanced imaging review. Pol J Radiol. 2016;81:629–35. https://doi.org/10.12659/PJR.899317.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Rowbotham EL, Grainger AJ. Rheumatoid arthritis: ultrasound versus MRI. AJR Am J Roentgenol. 2011;197:541–6. https://doi.org/10.2214/ajr.11.6798.

    Article  PubMed  Google Scholar 

  37. Di Matteo A, Mankia K, Azukizawa M, Wakefield RJ. The role of musculoskeletal ultrasound in the rheumatoid arthritis continuum. Curr Rheumatol Rep. 2020;22:41. https://doi.org/10.1007/s11926-020-00911-w.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Meng XH, Wang Z, Zhang XN, Xu J, Hu YC. Rheumatoid arthritis of knee joints: MRI-pathological correlation. Orthop Surg. 2018;10:247–54. https://doi.org/10.1111/os.12389.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Manara M, Varenna M. A clinical overview of bone marrow edema. Reumatismo. 2014;66:184–96. https://doi.org/10.4081/reumatismo.2014.790.

    Article  CAS  PubMed  Google Scholar 

  40. Filippucci E, Cipolletta E, Mashadi Mirza R, Carotti M, Giovagnoni A, Salaffi F, et al. Ultrasound imaging in rheumatoid arthritis. Radiol Med. 2019;124:1087–100. https://doi.org/10.1007/s11547-019-01002-2.

    Article  PubMed  Google Scholar 

  41. Okano T, Mamoto K, Di Carlo M, Salaffi F. Clinical utility and potential of ultrasound in osteoarthritis. Radiol Med. 2019;124:1101–11. https://doi.org/10.1007/s11547-019-01013-z.

    Article  PubMed  Google Scholar 

  42. Taylor PC. VEGF and imaging of vessels in rheumatoid arthritis. Arthritis Research & Therapy. 2002;4:S99. https://doi.org/10.1186/ar582.

    Article  Google Scholar 

  43. Brennan FM, McInnes IB. Evidence that cytokines play a role in rheumatoid arthritis. J Clin Invest. 2008;118:3537–45. https://doi.org/10.1172/JCI36389.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Antonelli A, Ferrari SM, Giuggioli D, Ferrannini E, Ferri C, Fallahi P. Chemokine (C–X–C motif) ligand (CXCL) 10 in autoimmune diseases. Autoimmun Rev. 2014;13:272–80. https://doi.org/10.1016/j.autrev.2013.10.010.

    Article  CAS  PubMed  Google Scholar 

  45. Hsieh W-S, Kung CC, Huang SL, Lin SC, Sun WH. TDAG8, TRPV1, and ASIC3 involved in establishing hyperalgesic priming in experimental rheumatoid arthritis. Sci Rep. 2017;7:8870. https://doi.org/10.1038/s41598-017-09200-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Lowin T, Apitz M, Anders S, Straub RH. Anti-inflammatory effects of N-acylethanolamines in rheumatoid arthritis synovial cells are mediated by TRPV1 and TRPA1 in a COX-2 dependent manner. Arthritis research & therapy. 2015;17:321. https://doi.org/10.1186/s13075-015-0845-5.

    Article  CAS  Google Scholar 

  47. Sano Y, Toyoshima S, Miki Y, Taketomi Y, Ito M, Lee H, et al. Activation of inflammation and resolution pathways of lipid mediators in synovial fluid from patients with severe rheumatoid arthritis compared with severe osteoarthritis. Asia Pacific Allergy. 2020;10. https://doi.org/10.5415/apallergy.2020.10.e21.

  48. Lin Y-J, Anzaghe M, Schülke S. Update on the pathomechanism, diagnosis, and treatment options for rheumatoid arthritis. Cells. 2020;9. https://doi.org/10.3390/cells9040880.

  49. Kavelaars A, Heijnen CJ. T cells as guardians of pain resolution. Trends Mol Med. 2021;27:302–13. https://doi.org/10.1016/j.molmed.2020.12.007.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Hafström I, Ajeganova S, Forslind K, Svensson B. Anti-citrullinated protein antibodies are associated with osteopenia but not with pain at diagnosis of rheumatoid arthritis: data from the BARFOT cohort. Arthritis research & therapy. 2019;21:45. https://doi.org/10.1186/s13075-019-1833-y.

    Article  Google Scholar 

  51. Hess A, Axmann R, Rech J, Finzel S, Heindl C, Kreitz S, et al. Blockade of TNF-α rapidly inhibits pain responses in the central nervous system. Proc Natl Acad Sci. 2011;108:3731–6. https://doi.org/10.1073/pnas.1011774108.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Maini R, St Clair EW, Breedveld F, Furst D, Kalden J, Weisman M, et al. Infliximab (chimeric anti-tumour necrosis factor α monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. Lancet. 1999;354:1932–9. https://doi.org/10.1016/s0140-6736(99)05246-0.

    Article  CAS  PubMed  Google Scholar 

  53. Singh JA, Christensen R, Wells GA, Suarez-Almazor ME, Buchbinder R, Lopez-Olivo MA, et al. Biologics for rheumatoid arthritis: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2010;128:309–10. https://doi.org/10.1590/s1516-31802010000500013.

    Article  Google Scholar 

  54. Guerne P-A, Zuraw BL, Vaughan JH, Carson DA, Lotz M. Synovium as a source of interleukin 6 in vitro. Contribution to local and systemic manifestations of arthritis. J Clin Invest. 1989;83:585–92. https://doi.org/10.1172/JCI113921.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Malemud CJ. The role of the JAK/STAT signal pathway in rheumatoid arthritis. Therapeutic advances in musculoskeletal disease. 2018;10(5-6):117–27. https://doi.org/10.1177/1759720X18776224.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Shinoda M, Honda T, Ozaki N, Hattori H, Mizutani H, Ueda M, et al. Nerve terminals extend into the temporomandibular joint of adjuvant arthritic rats. Eur J Pain. 2003;7:493–505. https://doi.org/10.1016/S1090-3801(03)00021-1.

    Article  PubMed  Google Scholar 

  57. Sokka T, Kankainen A, Hannonen P. Scores for functional disability in patients with rheumatoid arthritis are correlated at higher levels with pain scores than with radiographic scores. Arthritis & Rheumatism. Official Journal of the American College of Rheumatology. 2000; https://doi.org/10.1002/1529-0131(200002)43:2<386::AID-ANR19>3.0.CO;2-Z.

  58. Handwerker HO, Arendt-Nielson L. Pain models: translational relevance and applications. 1st ed. IASP: Washington; 2013.

    Google Scholar 

  59. Turk DC. IASP taxonomy of chronic pain syndromes: preliminary assessment of reliability. Pain. 1987;30:177–89. https://doi.org/10.1016/0304-3959(87)91073-6.

    Article  PubMed  Google Scholar 

  60. Shenker N, et al. Contralateral hyperalgesia and allodynia following intradermal capsaicin injection in man. Rheumatology. 2008;47:1417–21. https://doi.org/10.1093/rheumatology/ken251.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Khoonsari PE, Ossipova E, Lengqvist J, Svensson CI, Kosek E, Kadetoff D, et al. The human CSF pain proteome. J Proteome. 2019;190:67–76. https://doi.org/10.1016/j.jprot.2018.05.012.

    Article  CAS  Google Scholar 

  62. Wendler J, Hummel T, Reissinger M, Manger B, Pauli E, Kalden JR, et al. Patients with rheumatoid arthritis adapt differently to repetitive painful stimuli compared to healthy controls. Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia. 2001;8:272–7. https://doi.org/10.1054/jocn.1999.0775.

    Article  CAS  Google Scholar 

  63. Lee YC, Nassikas NJ, Clauw DJ. The role of the central nervous system in the generation and maintenance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgia. Arthritis Res Ther. 2011;13:211. https://doi.org/10.1186/ar3306.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Wang L, Jiang X, Zheng Q, Jeon SM, Chen T, Liu Y, et al. Neuronal FcγRI mediates acute and chronic joint pain. J Clin Invest. 2019;129:3754–69. https://doi.org/10.1172/JCI128010.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Burckhardt CS. The use of the McGill Pain Questionnaire in assessing arthritis pain. Pain. 1984;19:305–14. https://doi.org/10.1016/0304-3959(84)90007-1.

    Article  PubMed  Google Scholar 

  66. Hochman J, et al. Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis. Osteoarthr Cartil. 2013;21(9):1236–42. https://doi.org/10.1016/j.joca.2013.06.023.

    Article  CAS  Google Scholar 

  67. Rupp I, Boshuizen HC, Roorda LD, Dinant HJ, Jacobi CE, van den Bos G. Poor and good health outcomes in rheumatoid arthritis: the role of comorbidity. J Rheumatol. 2006;33(8):1488–95.

    PubMed  Google Scholar 

  68. Sturgeon JA, Finan PH, Zautra AJ. Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways. Nat Rev Rheumatol. 2016;12:532–42. https://doi.org/10.1038/nrrheum.2016.112.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Miller AH, Haroon E, Raison CL, Felger JC. Cytokine targets in the brain: impact on neurotransmitters and neurocircuits. Depress Anxiety. 2013;30:297–306. https://doi.org/10.1002/da.22084.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. de Heer EW, Gerrits MMJG, Beekman ATF, Dekker J, van Marwijk HWJ, de Waal MWM, et al. The association of depression and anxiety with pain: a study from NESDA. PLoS One. 2014;9:e106907. https://doi.org/10.1371/journal.pone.0106907.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Edwards RR, Cahalan C, Mensing G, Smith M, Haythornthwaite JA. Pain, catastrophizing, and depression in the rheumatic diseases. Nat Rev Rheumatol. 2011;7:216–24. https://doi.org/10.1038/nrrheum.2011.2.

    Article  CAS  PubMed  Google Scholar 

  72. Wood PB, Schweinhardt P, Jaeger E, Dagher A, Hakyemez H, Rabiner EA, et al. Fibromyalgia patients show an abnormal dopamine response to pain. Eur J Neurosci. 2007;25:3576–82. https://doi.org/10.1111/j.1460-9568.2007.05623.x.

    Article  PubMed  Google Scholar 

  73. Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain. 2006. https://doi.org/10.1016/j.jpain.2006.02.007.

  74. Metsios GS, Kitas GD. Physical activity, exercise and rheumatoid arthritis: effectiveness, mechanisms and implementation. Best Pract Res Clin Rheumatol. 2018;32:669–82. https://doi.org/10.1016/j.berh.2019.03.013.

    Article  PubMed  Google Scholar 

  75. Verhoeven F, Tordi N, Prati C, Demougeot C, Mougin F, Wendling D. Physical activity in patients with rheumatoid arthritis. Joint bone spine. 2016;83:265–70. https://doi.org/10.1016/j.jbspin.2015.10.002.

    Article  PubMed  Google Scholar 

  76. Roodenrijs N, Hamar A, Kedves M, Nagy G, van Laar JM, van der Heijde D, et al. Pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis. RMD. 2021;7:e001512. https://doi.org/10.1136/rmdopen-2020-001512.

    Article  Google Scholar 

  77. Busch AJ, Webber SC, Brachaniec M, Bidonde J, Bello-Haas VD, Danyliw AD, et al. Exercise therapy for fibromyalgia. Curr Pain Headache Rep. 2011;15:358–67. https://doi.org/10.1007/s11916-011-0214-2.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Vignon E, Valat JP, Rossignol M, Avouac B, Rozenberg S, Thoumie P, et al. Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS). Joint bone spine. 2006;73:442–55. https://doi.org/10.1016/j.jbspin.2006.03.001.

    Article  PubMed  Google Scholar 

  79. Sharpe L. Psychosocial management of chronic pain in patients with rheumatoid arthritis: challenges and solutions. J Pain Res. 2016. https://doi.org/10.2147/JPR.S83653.

  80. Boyden SD, Hossain IN, Wohlfahrt A, Lee YC. Non-inflammatory causes of pain in patients with rheumatoid arthritis. Curr Rheumatol Rep. 2016;18:30. https://doi.org/10.1007/s11926-016-0581-0.

    Article  CAS  PubMed  Google Scholar 

  81. Lee YC. Effect and treatment of chronic pain in inflammatory arthritis. Curr Rheumatol Rep. 2013;15:300. https://doi.org/10.1007/s11926-012-0300-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Crofford LJ. Use of NSAIDs in treating patients with arthritis. Arthritis research & therapy. 2013. https://doi.org/10.1186/ar4174.

  83. Richette P. Approches thérapeutiques de l’arthrose [Pharmacological therapies for osteoarthritis]. Therapie. 2011;66:383–90. https://doi.org/10.2515/therapie/2011060.

    Article  PubMed  Google Scholar 

  84. Towheed TE, Maxwell L, Judd MG, Catton M, Hochberg MC, Wells G. Acetaminophen for osteoarthritis. The Cochrane database of systematic reviews. 2006. https://doi.org/10.1002/14651858.CD004257.

  85. Day AL, Curtis JR. Opioid use in rheumatoid arthritis: trends, efficacy, safety, and best practices. Curr Opin Rheumatol. 2019;31:264–70. https://doi.org/10.1097/BOR.0000000000000602.

    Article  CAS  PubMed  Google Scholar 

  86. Richards BL, Whittle SL, Buchbinder R. Neuromodulators for pain management in rheumatoid arthritis. The Cochrane database of systematic reviews. 2012. https://doi.org/10.1002/14651858.CD008921.pub2.

  87. Shneker BF, McAuley JW. Pregabalin: a new neuromodulator with broad therapeutic indications. Ann Pharmacother. 2005;39:2029–37. https://doi.org/10.1345/aph.1G078.

    Article  CAS  PubMed  Google Scholar 

  88. Welsch P, Üçeyler N, Klose P, Walitt B, Häuser W. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst Rev. 2018. https://doi.org/10.1002/14651858.CD010292.

  89. English C, Rey JA, Rufin C. Milnacipran (Savella), A treatment option for fibromyalgia. P T. 2010;35(5):261–6.

    PubMed Central  Google Scholar 

  90. Kiso T, Moriyama A, Furutani M, Matsuda R, Funatsu Y. Effects of pregabalin and duloxetine on neurotransmitters in the dorsal horn of the spinal cord in a rat model of fibromyalgia. Eur J Pharmacol. 2018;827:117–24. https://doi.org/10.1016/j.ejphar.2018.03.011.

    Article  CAS  PubMed  Google Scholar 

  91. Bullock J, Rizvi S, Saleh AM, Ahmed SS, Do DP, Ansari RA, et al. Rheumatoid arthritis: a brief overview of the treatment. Medical principles and practice: international journal of the Kuwait University. Health Science Centre. 2018;27:501–7. https://doi.org/10.1159/000493390.

    Article  Google Scholar 

  92. Berardicurti O, Ruscitti P, Pavlych V, Conforti A, Giacomelli R, Cipriani P. Glucocorticoids in rheumatoid arthritis: the silent companion in the therapeutic strategy. Expert Rev Clin Pharmacol. 2020;13:593–604. https://doi.org/10.1080/17512433.2020.17720.

    Article  CAS  PubMed  Google Scholar 

  93. Heidari B. Rheumatoid arthritis: early diagnosis and treatment outcomes. Caspian journal of internal medicine. 2011;2(1):161–70.

    PubMed  PubMed Central  Google Scholar 

  94. Nell VP, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology. 2004;43:906–14. https://doi.org/10.1093/rheumatology/keh19.

    Article  CAS  PubMed  Google Scholar 

  95. Godwin M, Dawes M. Intra-articular steroid injections for painful knees. Systematic review with meta-analysis. Canadian family physician Medecin de famille canadien. 2004;50:241–8.

    PubMed  PubMed Central  Google Scholar 

  96. Konai MS, Vilar Furtado RN, Dos Santos MF, Natour J. Monoarticular corticosteroid injection versus systemic administration in the treatment of rheumatoid arthritis patients: a randomized double-blind controlled study. Clin Exp Rheumatol. 2009;27(2):214–21.

    CAS  PubMed  Google Scholar 

  97. Gvozdenović E, Dirven L, van den Broek M, Han KH, Molenaar ET, Landewé RB, et al. Intra articular injection with corticosteroids in patients with recent onset rheumatoid arthritis: subanalyses from the BeSt study. Clin Rheumatol. 2014;33:263–7. https://doi.org/10.1007/s10067-013-2465-2.

    Article  PubMed  Google Scholar 

  98. Cheng OT, Souzdalnitski D, Vrooman B, Cheng J. Evidence-based knee injections for the management of arthritis. Pain Med. 2012;13:740–53. https://doi.org/10.1111/j.1526-4637.2012.01394.x.

    Article  PubMed  Google Scholar 

  99. Altman RD, Manjoo A, Fierlinger A, Niazi F, Nicholls M. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord. 2015;16:321. https://doi.org/10.1186/s12891-015-0775-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  100. Chou CL, Li HW, Lee SH, Tsai KL, Ling HY. Effect of intra-articular injection of hyaluronic acid in rheumatoid arthritis patients with knee osteoarthritis. Journal of the Chinese Medical Association: JCMA. 2008. https://doi.org/10.1016/S1726-4901(08)70092-3.

  101. Shen L, Yuan T, Chen S, Xie X, Zhang C. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 2017;12:16. https://doi.org/10.1186/s13018-017-0521-3.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Le A, Enweze L, DeBaun MR, Dragoo JL. Current clinical recommendations for use of platelet-rich plasma. Current reviews in musculoskeletal medicine. 2018;11:624–34. https://doi.org/10.1007/s12178-018-9527-7.

    Article  PubMed  PubMed Central  Google Scholar 

  103. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2020;72:149–62. https://doi.org/10.1002/acr.24131.

  104. Singh JA, Saag KG, Bridges SL Jr, Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheum. 2016;68:1–26. https://doi.org/10.1002/art.39480.

  105. Kanashiro A, et al. From neuroimunomodulation to bioelectronic treatment of rheumatoid arthritis. Bioelectronics in medicine. 2019. https://doi.org/10.2217/bem-2018-0001.

  106. Deare JC, Zheng Z, Xue CC, Liu JP, Shang J, Scott SW, et al. Acupuncture for treating fibromyalgia. Cochrane Database Syst Rev. 2013. https://doi.org/10.1002/14651858.CD007070.pub2.

  107. Ramos A, Domínguez J, Gutiérrez S. Acupuncture for rheumatoid arthritis. Medwave: Acupuntura para el tratamiento de la artritis reumatoide; 2018. https://doi.org/10.5867/medwave.2018.06.7283.

    Book  Google Scholar 

  108. Chakravarthy KV, Xing F, Bruno K, Kent AR, Raza A, Hurlemann R, et al. A review of spinal and peripheral neuromodulation and neuroinflammation: lessons learned thus far and future prospects of biotype development. Neuromodulation. 2019;22:235–43. https://doi.org/10.1111/ner.12859.

    Article  PubMed  Google Scholar 

  109. Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O, et al. A randomized, controlled trial of total knee replacement. N Engl J Med. 2015;373:1597–606. https://doi.org/10.1056/NEJMoa1505467.

    Article  CAS  PubMed  Google Scholar 

  110. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2:e000435. https://doi.org/10.1136/bmjopen-2011-000435.

    Article  PubMed  PubMed Central  Google Scholar 

  111. Gwinnutt JM, Symmons DPM, MacGregor AJ, et al. Predictors of and outcomes following orthopaedic joint surgery in patients with early rheumatoid arthritis followed for 20 years. Rheumatology. 2017. https://doi.org/10.1093/rheumatology/kex172.

  112. Ravi B, Escott B, Shah PS, Jenkinson R, Chahal J, Bogoch E, et al. A systematic review and meta-analysis comparing complications following total joint arthroplasty for rheumatoid arthritis versus for osteoarthritis. Arthritis Rheum. 2012;64:3839–49. https://doi.org/10.1002/art.37690.

    Article  PubMed  Google Scholar 

  113. Cordtz RL, Zobbe K, Højgaard P, Kristensen LE, Overgaard S, Odgaard A, et al. Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers. Ann Rheum Dis. 2018;77:281–8. https://doi.org/10.1136/annrheumdis-2017-212339.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Chicago, Chicago, IL, USA

    Kristen Mathias

  2. Department of Internal Medicine, Division of Rheumatology, Los Angeles County + University of Southern California (LAC + USC) and Keck Medicine of USC, Los Angeles, CA, USA

    Abhimanyu Amarnani & Daniel Arkfeld

  3. Texas A&M School of Medicine, Bryan, TX, USA

    Neha Pal

  4. Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA

    Jay Karri

  5. Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA

    Jonathan M. Hagedorn

  6. Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Alaa Abd-Elsayed

Authors
  1. Kristen Mathias
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abhimanyu Amarnani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Neha Pal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jay Karri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Arkfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jonathan M. Hagedorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alaa Abd-Elsayed
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All named authors meet the ICMJE criteria for authorship, take responsibility for the integrity of this work, and have given their approval for publication.

Corresponding author

Correspondence to Alaa Abd-Elsayed.

Ethics declarations

Conflict of Interest

JMH is a consultant for Abbott, Boston Scientific, and Nevro. AA-E is a consultant for Medtronic, StimWave, Avanos, and Sollis. The remaining authors have no conflicts of interest to disclose.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Neuropathic Pain

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mathias, K., Amarnani, A., Pal, N. et al. Chronic Pain in Patients with Rheumatoid Arthritis. Curr Pain Headache Rep 25, 59 (2021). https://doi.org/10.1007/s11916-021-00973-0

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11916-021-00973-0

Keywords

Search

Navigation