Abstract
Although pain in rheumatoid arthritis (RA) is frequently thought to be inflammatory in nature, the association between measures of inflammation and pain intensity is low. This observation is likely due to the multifactorial nature of pain. In addition to pain from joint inflammation, RA patients may also have pain due to structural damage or central etiologies, such as aberrancies in the central nervous system (CNS) pain regulatory pathways. These CNS pathways include mechanisms that facilitate pain, as well as mechanisms that inhibit pain. Other factors, such as sleep disturbances, depression, anxiety, and catastrophizing, may also impact the perception of pain in RA patients. Since pain is frequently used as a proxy for inflammation in the assessment of RA disease activity, it is important that patients and physicians recognize that not all pain is inflammatory, and alternative management strategies, other than escalating disease-modifying antirheumatic drug treatment, may need to be considered.
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SDB and INH declare that they have no conflicts of interest. AW reports receiving salary support from a grant from Forest Research Institute, outside the submitted work. YCL reports grants from Forest Research Institute, other stock in Merck, stock in Novartis, and stock in Perrigo, outside the submitted work.
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YCL receives funding from the NIH-NIAMS (R01 AR064850).
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This article is part of the Topical Collection on Rheumatoid Arthritis
Sean D. Boyden and Imtiyaz N. Hossain are co-first authors
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Boyden, S.D., Hossain, I.N., Wohlfahrt, A. et al. Non-inflammatory Causes of Pain in Patients with Rheumatoid Arthritis. Curr Rheumatol Rep 18, 30 (2016). https://doi.org/10.1007/s11926-016-0581-0
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DOI: https://doi.org/10.1007/s11926-016-0581-0