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

中文翻译：

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类风湿性关节炎患者的慢性疼痛

审查目的

慢性疼痛在类风湿性关节炎 (RA) 患者中非常普遍，可导致各种身体和心理障碍。不幸的是，在该人群中正确诊断慢性疼痛综合征可能具有挑战性，因为疼痛可能主要是 RA 特异性炎症和/或继发于其他疾病，通常是骨关节炎 (OA) 和纤维肌痛 (FM)。这种差异进一步带来了临床挑战，因为慢性疼痛通常与标准的 RA 特异性监测策略不一致或无法检测到，包括血清学标志物和影像学研究。在这篇综述中，我们对 RA 人群中的慢性疼痛进行了有力的探索，重点是流行病学、机制和管理策略。

最近的发现

与 RA 相关的慢性疼痛通常发生在焦虑、女性和炎症状态升高的患者中。尽管进行了适当的炎症抑制，但其中高达 50% 的患者被认为患有慢性疼痛，这通常是由于外周和中枢敏感以及继发性 OA 和 FM。除了 OA 和 FM 的标准护理管理之外，RA 和慢性疼痛患者还可以从行为和心理治疗方案中受益。此外，存在早期和多模式疗法，包括非药物、药物、介入和手术策略，尽管功效各不相同，但可以帮助抑制炎症、提供必要的镇痛和优化功能结果。

概括

总的来说，RA 的慢性疼痛对患者和提供者来说都是一个困难的实体。早期诊断、提高对其机制的理解以及早期、有针对性的疼痛控制方法的启动可能有助于改善这一人群的结果