Pain in rheumatoid arthritis: a critical review

Reumatismo. 2014 Jun 6;66(1):18-27. doi: 10.4081/reumatismo.2014.760.


Patients with rheumatoid arthritis (RA) are frequently afflicted by pain, which may be caused by joint inflammation (leading to structural joint damage) or secondary osteoarthritis, and may be increased by central sensitisation. Non-inflammatory pain may also confuse the assessment of disease activity, and so the aim of treatment is not only to combat inflammatory disease, but also relieve painful symptoms. In order to ensure effective treatment stratification, it is necessary to record a patients medical history in detail, perform a physical examination, and objectively assess synovitis and joint damage. The management of pain requires various approaches that include pharmacological analgesia and biological and non-biological treatments. Although joint replacement surgery can significantly improve RA-related pain, it may only be available to patients with the most severe advanced disease.

Publication types

  • Review

MeSH terms

  • Analgesics / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Rheumatoid / immunology
  • Arthritis, Rheumatoid / physiopathology
  • Central Nervous System Sensitization
  • Chronic Pain / diagnosis
  • Chronic Pain / physiopathology*
  • Chronic Pain / psychology
  • Chronic Pain / therapy
  • Cognitive Behavioral Therapy
  • Combined Modality Therapy
  • Exercise Therapy
  • Fibromyalgia / complications
  • Fibromyalgia / drug therapy
  • Fibromyalgia / physiopathology
  • Humans
  • Inflammation
  • Musculoskeletal Pain / diagnosis
  • Musculoskeletal Pain / physiopathology*
  • Musculoskeletal Pain / psychology
  • Musculoskeletal Pain / therapy
  • Neurotransmitter Agents / physiology
  • Osteoarthritis / complications
  • Osteoarthritis / physiopathology
  • Pain Management
  • Pain Measurement
  • Pain Perception
  • Pain Threshold / physiology


  • Analgesics
  • Anti-Inflammatory Agents, Non-Steroidal
  • Antirheumatic Agents
  • Neurotransmitter Agents