Pain is a significant issue in rheumatoid arthritis (RA) and can have a negative impact on patients' quality of life. Despite optimal control of inflammatory disease, residual chronic pain remains a major unmet medical need in RA. Pain in RA can be secondary to inflammation but can also generate neuroendocrine responses that initiate neurogenic inflammation and enhance cytokine release, leading to persistent hyperalgesia. In addition to well-known cytokines such as TNFα and IL-6, other cytokines and the JAK-STAT pathway play a role in pain modulation and inflammation. The development of chronic pain in RA involves processes beyond inflammation or structural damage. Residual pain is often observed in patients even after achieving remission or low disease activity, suggesting the involvement of non-inflammatory and central sensitization mechanisms. Moreover, fibromyalgia syndrome (FMS) is prevalent in RA patients and may contribute to persistent pain. Factors such as depression, sleep disturbance, and pro-inflammatory cytokines may contribute to the development of fibromyalgia in RA. It is essential to identify and diagnose concomitant FMS in RA patients to better manage their symptoms. Further research is needed to unravel the complexities of pain in RA. Finally, recent studies have shown that JAK inhibitors effectively reduce residual pain in RA patients, suggesting pain-reducing effects independent of their anti-inflammatory properties.

中文翻译：

---

转载《类风湿性关节炎的残余疼痛：这是一个真正的问题吗？》

疼痛是类风湿性关节炎 (RA) 的一个重要问题，会对患者的生活质量产生负面影响。尽管炎症性疾病得到了最佳控制，但残留的慢性疼痛仍然是 RA 中未满足的主要医疗需求。 RA 中的疼痛可能继发于炎症，但也可能产生神经内分泌反应，引发神经源性炎症并增强细胞因子释放，导致持续性痛觉过敏。除了众所周知的细胞因子（如 TNFα 和 IL-6）外，其他细胞因子和 JAK-STAT 通路也在疼痛调节和炎症中发挥作用。 RA 慢性疼痛的发展涉及炎症或结构损伤以外的过程。即使在达到缓解或疾病活动度较低后，患者仍经常观察到残余疼痛，这表明涉及非炎症和中枢敏化机制。此外，纤维肌痛综合征 (FMS) 在 RA 患者中很常见，可能会导致持续性疼痛。抑郁、睡眠障碍和促炎细胞因子等因素可能导致 RA 纤维肌痛的发生。识别和诊断 RA 患者伴随的 FMS 对于更好地管理他们的症状至关重要。需要进一步的研究来阐明 RA 疼痛的复杂性。最后，最近的研究表明，JAK 抑制剂可有效减轻 RA 患者的残余疼痛，表明其减轻疼痛的效果与其抗炎特性无关。