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Pain is the main problem that sends patients to rheumatologists, but studies of medication for rheumatic disorders such as RA have focused on inflammation, not pain. A review points out what is not known currently about analgesia in inflammatory arthritis and urgently needs to be studied.
Although as many as nine of ten rheumatoid arthritis (RA) patients rate pain as one of their top three priorities, most studies of medication for inflammatory arthritis have focused on reducing inflammation rather than on pain per se, observes rheumatologist Yvonne C. Lee MD of Brigham and Women's Hospital in a review in Current Rheumatology Reports. Many RA patients continue to feel pain despite effective DMARD treatment, she notes.
The review states that more research is needed to learn how best to resolve this pain. Non-pharmacologic interventions such as cognitive therapy do show clear benefit for some conditions, it says. But although a recent multinational consensus report (Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative)
gave recommendations for pain management in inflammatory arthritis, it could not identify sufficient studies of high quality to allow a firm conclusion about pharmacologic methods of analgesia. Many studies of pharmacological analgesics were more than a decade old and did not include DMARDs.
Research is lacking most notably on the following topics, Lee writes:
• Combination therapy, particularly for combinations of DMARDs and analgesics
• Analgesia for patients who have comorbidities in addition to inflammatory arthritis
• Effectiveness and safety of opioids and antidepressants for pain relief in this patient population
The presence of pain also has an impact on disease status, notes the review, particularly for patient assessments but also to a lesser degree on physician global assessments. Because pain frequently does not correlate directly with the degree of inflammation, Lee writes that "physicians should carefully consider the effect of fibromyalgia on disease assessment measures when evaluating inflammatory arthritis disease activity."