A heightened reactivity to pain is assumed to play a significant role in the maintenance and exacerbation of pain in patients with chronic pain. In a prospective study involving 95 rheumatoid arthritis (RA) patients, the relative contribution of self-reported cognitive, behavioral and physiological components of pain reactivity were examined for a change in pain within 1 year. Regression analyses indicated that self-reported physiological reactivity predicted an increase in clinical and self-reported pain after 1 year, but not cognitive and behavioral reactivity. Neither disease activity nor neuroticism mediated or moderated the relationship of pain reactivity to long-term pain. However, structural equation modeling revealed that neuroticism directly affected physiological reactivity to pain, which in turn was the only significant predictor for subsequent pain. The results of this study underline the crucial role of physiological pain reactivity for exacerbation of pain in RA patients and are indicative for a symptom-specific pattern of physiological pain reactivity that is sustained by psychological predisposition and respondent learning processes.