Assessment of pain in rheumatoid arthritis. Practical significance
The chief complaint of patients with rheumatoid arthritis (RA) is pain. The latter is one of the main signs of chronic inflammation, which holds a central position in the clinical picture of the disease. Pain is not among the baseline parameters that are used to calculate total disease activity indices. Nevertheless, pain greatly influences the result of RA activity determination using the total indices. However, this assessment system can take into account only the intensity of pain, whereas the clinical significance of pain syndrome is largely determined by its nature. The causes of pain in RA can be different in different patients and even in one patient at early and late stages of the disease, during the periods of exacerbation and attenuation of the inflammatory activity. Pain in RA is not always associated with the active inflammatory process. At the same time, intense non-inflammatory pain can significantly affect the traditional indicators of inflammatory activity, by distorting the result of quantitative determination of disease activity. In turn, an erroneous activity assessment may cause an incorrect choice of treatment policy. Therefore, the clinical use of tools that reliably determine the nature of pain, can contribute to a significant improvement in the quality of care for RA patients. In most cases pain in RA is associated with inflammatory changes in joints or periarticular soft tissues. Therefore along with disease-modifying anti-rheumatic drugs, nonstreroidal anti-inflammatory drugs (NSAIDs) are widely used in the combination therapy of RA. However, their use is limited by a risk of adverse reactions. Etoricoxib is one of the highly effective drugs with a good safety profile. Currently, there are no recommendations for the treatment of neuropathic pain in patients with RA. Investigating the efficacy of tricyclic antidepressants and cannabinoids in RA has failed to prove their advantages over placebo.