Background Pain control in rheumatoid arthritis (RA) is often inadequate and clinically significant pain persists in a substantial proportion of patients, even when inflammation appears to be well controlled. This suggests that inflammation or subsequent joint damage might not be the only factor causing pain in RA. Accumulating evidence suggests that features of neuropathic pain may also be present in patients with rheumatic pain conditions.
Objectives To estimate the prevalence and factors associated with neuropathic-like pain symptoms in patients with rheumatoid arthritis (RA).
Methods A cross-sectional sample of 159 RA patients completed the painDETECT questionnaire along with other self-reported measures before their visit to the rheumatology outpatient clinic. Univariate analyses and multivariable logistic regression were used to identify factors associated with neuropathic pain features.
Results The large majority of patients (88%) were in remission or had low disease activity, but 44% of the patients continued to report clinically significant pain. According to the painDETECT, 27 patients (17.0%) were classified as having likely neuropathic pain and 34 patients (21.4%) as having possible neuropathic pain. Besides reporting more intense pain, patients with likely or possible neuropathic pain were more likely to meet the diagnostic criteria for fibromyalgia, to use analgesics, and to have more tender joints and worse physical and mental health status as measured by the SF-36. In multivariable analysis, physical (P<0.001) and mental health status (P=0.006) remained significantly associated with neuropathic pain features, even after controlling for pain severity.
Conclusions Neuropathic-like pain symptoms are present in a substantial number of patients with RA and are associated with worse physical and mental health. These symptoms may represent central sensitization and underscore the need for further research and screening of pain mechanisms in RA patients.
Disclosure of Interest None declared