Review Article

Mechanisms, impact and management of pain in rheumatoid arthritis

  • Nature Reviews Rheumatology volume 10, pages 581592 (2014)
  • doi:10.1038/nrrheum.2014.64
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Abstract

People with rheumatoid arthritis (RA) identify pain as their most important symptom, one that often persists despite optimal control of inflammatory disease. RA pain arises from multiple mechanisms, involving inflammation, peripheral and central pain processing and, with disease progression, structural change within the joint. Consequently, RA pain has a wide range of characteristics—constant or intermittent, localized or widespread—and is often associated with psychological distress and fatigue. Dominant pain mechanisms in an individual are identified by critical evaluation of clinical symptoms and signs, and by laboratory and imaging tests. Understanding these mechanisms is essential for effective management, although evidence from preclinical models should be interpreted with caution. A range of pharmacological analgesic and immunomodulatory agents, psychological interventions and surgery may help manage RA pain. Pain contributes importantly to the clinical assessment of inflammatory disease activity, and noninflammatory components of RA pain should be considered when gauging eligibility for or response to biologic agents. Further randomized controlled trials are required to determine the optimal usage of analgesics in RA, and novel agents with greater efficacy and lower propensity for adverse events are urgently needed. Meanwhile, targeted use of existing treatments could reduce pain in people with RA.

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Author information

Affiliations

  1. Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.

    • David A. Walsh
    •  & Daniel F. McWilliams

Authors

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Contributions

Both authors researched the data for the article, provided substantial contributions to discussions of content, wrote the article and undertook review and/or editing of the manuscript before submission.

Competing interests

D.A.W. is the holder of an Inflammation Competitive Research Programme (I-CRP) grant from Pfizer UK, and has previously acted as a consultant for Pfizer. D.F.M. is supported by the I-CRP grant.

Corresponding author

Correspondence to David A. Walsh.