Non-inflammatory pain in inflammatory arthritis

Das, Dhivya and Choy, Ernest ORCID: https://orcid.org/0000-0003-4459-8609 2023. Non-inflammatory pain in inflammatory arthritis. Rheumatology 62 (7) , pp. 2360-2365. 10.1093/rheumatology/keac671

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Abstract

‘Non-inflammatory’ pain, pain that is not associated with measures of inflammation, is common in patients with inflammatory arthritis including RA. One important cause of non-inflammatory pain is concomitant fibromyalgia. Systematic review has shown that fibromyalgia is common in inflammatory arthritis including RA affecting 1 in 5 patients and is associated with higher disease activity scores due to inflated tender joint count and patient global assessment. Consequently, many patients with RA and concomitant fibromyalgia may fail to reach treatment target and switch to alternate disease modifying drugs frequently. European Alliance of Association for Rheumatology has highlighted that concomitant fibromyalgia is an important consideration in assessing difficult-to-treat RA. The incidence and prevalence of fibromyalgia are higher in RA than the general population, raising the possibility that fibromyalgia may be ‘secondary’ to RA rather than a concomitant disease. The precise mechanisms whereby patients with RA develop fibromyalgia are unknown. In this review, we discussed fibromyalgia in RA, its clinical impact and epidemiology as well as data suggesting fibromyalgia might be ‘secondary’. Lastly, we reviewed potential pathogenic mechanisms which included inflammatory cytokines sensitizing nociceptive neurones, temporal summation, also known as windup, from chronic pain and impaired coping from poor quality sleep and mental well-being. Deciphering the exact mechanisms may lead to treatment strategies that prevent development of secondary fibromyalgia and will address a common factor associated with difficult-to-treat RA.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Oxford University Press
ISSN:	1462-0324
Date of First Compliant Deposit:	4 January 2023
Date of Acceptance:	19 November 2022
Last Modified:	16 Aug 2023 16:21
URI:	https://orca.cardiff.ac.uk/id/eprint/155400

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