Kristen Mathias1, Abhimanyu Amarnani2, Neha Pal3, Jay Karri4, Daniel Arkfeld2, Jonathan M Hagedorn5, Alaa Abd-Elsayed6. 1. Department of Internal Medicine, University of Chicago, Chicago, IL, USA. 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. 3. Texas A&M School of Medicine, Bryan, TX, USA. 4. Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA. 5. Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA. 6. Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. alaaawny@hotmail.com.
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. 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.
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. 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.
Authors: P Sarzi-Puttini; F Salaffi; M Di Franco; L Bazzichi; G Cassisi; R Casale; M Cazzola; S Stisi; M Battellino; F Atzeni Journal: Reumatismo Date: 2014-06-06
Authors: Maria Fernanda Brandão Resende Guimarães; Maria Raquel da Costa Pinto; Gustavo Gomes Resende; Carla Jorge Machado; Ana Beatriz Vargas-Santos; Rodrigo Balbino Chaves Amorim; Ana Paula Monteiro Gomides; Cleandro Pires de Albuquerque; Manoel Barros Bértolo; Paulo Louzada Júnior; Isabela Araújo Santos; Rina Dalva Neubarth Giorgi; Nathalia de Carvalho Saciloto; Sebastião Cezar Radominski; Fernanda Maria Borghi; Karina Rossi Bonfiglioli; Henrique Carriço da Silva; Maria de Fátima L da Cunha Sauma; Marcel Lobato Sauma; Júlia Brito de Medeiros; Ivânio Alves Pereira; Gláucio Ricardo Werner de Castro; Claiton Viegas Brenol; Ricardo Machado Xavier; Licia Maria Henrique Mota; Geraldo da Rocha Castelar-Pinheiro Journal: PLoS One Date: 2020-03-13 Impact factor: 3.240