Pain in systemic inflammatory rheumatic diseases.
The sometimes intense, persistent and disabling pain associated with rheumatoid arthritis (RA) and spondyloarthritis frequently has a multifactorial, simultaneously central and peripheral origin, and it may be due to currently active inflammation or joint damage and tissue destruction caused by a previous inflammatory condition. The symptoms of inflammatory pain symptoms can be partially relieved by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in central pain regulation mechanisms, as in the case of the chronic widespread pain (CWP) characterising fibromyalgia. The importance of distinguishing CWP from inflammatory pain is underlined by the fact that drugs such as tumour necrosis factor inhibitors are expensive, and direct costs are higher in patients with concomitant CWP than in those without. The management of pain requires a combination approach that includes pharmacological analgesia, and biological and non-biological treatments because, although joint replacement surgery can significantly improve RA-related pain, it may only be available to patients with the most severe advanced disease.
IRCCS Galeazzi Orthopedic Institute, Milan, Italy. Electronic address: atzenifabiola@hotmail.com.
Fabiola
F
Atzeni
Orthopedic Unit, Santissima Trinità Hospital, Cagliari, Italy.
Ignazio Francesco
IF
Masala
Chair of Rheumatology, Università Politecnica delle Marche, Italy.
Fausto
F
Salaffi
Chair of Rheumatology, La Sapienza University, Rome, Italy.
Manuela
M
Di Franco
Department of Clinical Neurophysiology and Pain Rehabilitation Unit (RC), Foundation Salvatore Maugeri IRCCS, Montescano, Italy.
Roberto
R
Casale
Rheumatology Unit, L.Sacco University Hospital, Milan, Italy.
Piercarlo
P
Sarzi-Puttini
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D059350:Chronic Pain / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000188:drug therapy; D059408:Pain Management / Q000379:methods*; D025241:Spondylarthritis / Q000150:complications* / Q000188:drug therapy
D000894:Anti-Inflammatory Agents, Non-Steroidal
Arthritides; Chronic pain; Inflammation; Pharmacological therapy