From 3 major aspects, look at the pain management of rheumatoid arthritis

Rheumatoid arthritis (RA) is characterized by symmetrical swelling and pain in multiple joints such as hands, wrists, and feet.

Among them, pain is the most important symptom of RA, and even with optimal control of the inflammatory disease, pain symptoms persist

RA pain will seriously affect the quality of life of patients , causing sleep disorders, depression, anxiety, etc.

Therefore, clinical attention should be paid to the management

1.

An individual's primary pain mechanism should be determined through rigorous evaluation of clinical signs and symptoms, as well as laboratory and imaging studies

• Understand the patient's medical history and disease progression

  
  

• Physical examination of localized pain should be assessed for myofascial and neuropathic pain in the muscles and soft tissues in addition to the joints

  
  

• X-ray examinations are performed to understand cartilage erosion and inflammatory changes, and MRI examinations are required if radiculopathy or plexopathy is suspected, or new headaches are present

  
  

• In patients with suspected neuropathic damage, tests such as electromyography and nerve conduction velocity should be performed

  
  

• Because patients with chronic pain are often accompanied by varying degrees of anxiety or depression, psychological and mental status should be evaluated in such patients

  
  

2.

The principles of treatment are ① clear diagnosis and active treatment of the primary disease; ② simultaneous pathological treatment and psychological adjustment; ③ comprehensive treatment with multiple methods

non-drug treatment

Mainly through psychological intervention, self-regulation measures (such as acupuncture , yoga, biofeedback therapy) to relieve pain

medical treatement

a.

Topical NSAIDs and intravenous injection preparations are easy to use and are one of the most commonly used analgesics in clinical practice

b.
Opioid analgesics: Opioids are mainly suitable for patients with moderate to severe chronic pain who use NSAIDs and other poor efficacy, or cannot tolerate the adverse reactions of gastrointestinal tract
caused by NSAIDs .
Common drugs include strong opioids morphine, oxycodone, tramadol, fentanyl, buprenorphine, etc.
, weak opioids codeine, tramadol,
etc.

Opioids are administered in a variety of ways, including oral, injection, and patches (such as buprenorphine transdermal patches, fentanyl transdermal patches, etc.
)
.
Adverse reactions include nausea, vomiting, drowsiness, respiratory depression, constipation, etc.
Long-term use may lead to addiction
.
When using opioids in elderly patients, attention should be paid to the lowest effective dose, and slow-release dosage forms or transdermal patches should be used as much as possible
.

c.
Anticonvulsants and antidepressants: Anticonvulsants are mainly used in the treatment of chronic neuropathic pain and fibromyalgia, especially for neuropathic pain of burning, tearing and numbing pain
.
Commonly used clinical drugs include pregabalin, carbamazepine, gabapentin, topiramate, zonisamide, lamotrigine, oxcarbazepine, levetiracetam,
etc.

interventional therapy

If the patient develops radicular pain, interventional therapy may be considered, including intra-articular injection of the sacroiliac joint, medial branch block, and radiofrequency ablation
.

Surgical treatment

Arthroscopic synovectomy can be performed to slow disease progression and chronic pain in RA patients
.
The timing of surgery is for patients with joint pain, no obvious structural damage, and ineffective drug treatment for more than 6 months
.
However, it is not recommended for patients with advanced RA with a high failure rate
.

For joints with moderate to severe destruction of the articular cartilage and subchondral bone, total joint arthroplasty can result in resolution of joint pain, correction of deformity, and improvement in function
.

3.
Relieve joint pain and strengthen comprehensive management

In addition to considering laboratory indicators such as the number of swollen joints, erythrocyte sedimentation rate, C-reactive protein, and extra-articular involvement, joint pain is also an important consideration and a predictor of the progression of joint damage in the selection of RA treatment options
.

Traditional disease-modifying antirheumatic drug therapy (DMARDs) should be started as soon as possible in RA patients
.
It is recommended that methotrexate alone is the first choice, and the efficacy should be evaluated after 1-3 months of methotrexate treatment.
For patients who have not reached the standard of treatment and have poor prognostic factors, methotrexate combined with biologics DMARDs can be considered.
Necrosis factor-α (TNF-α) inhibitors are currently well-documented and widely used biological DMARDs for the treatment of RA, including adalimumab, etanercept, and infliximab
.

During the treatment process, patients need to emphasize standardized, long-term treatment, monitoring and life>
.

Rheumatoid arthritis (RA) is characterized by symmetrical swelling and pain in multiple joints such as hands, wrists, and feet.
It is often accompanied by morning stiffness, and may be accompanied by systemic symptoms such as fatigue, low-grade fever, muscle aches, and weight loss
.

Among them, pain is the most important symptom of RA, and even with optimal control of the inflammatory disease, pain symptoms persist
.
Pain in RA is caused by multiple mechanisms involving inflammation, peripheral and central nervous system responses, and changes in joint structure as the disease progresses
.

RA pain will seriously affect the quality of life of patients , causing sleep disorders, depression, anxiety, etc.
, and even lead to digestive system dysfunction further aggravating the disease, restricting activities and even increasing the risk of thrombosis , bringing a serious economic burden to the patient's family.

.

Therefore, clinical attention should be paid to the management
of RA pain .

1.
Managing RA pain starts with exploring its mechanisms

An individual's primary pain mechanism should be determined through rigorous evaluation of clinical signs and symptoms, as well as laboratory and imaging studies
.

• Understand the patient's medical history and disease progression
  .
  

Understand the patient's medical history and disease progression
.

• Physical examination of localized pain should be assessed for myofascial and neuropathic pain in the muscles and soft tissues in addition to the joints
  .
  

Physical examination of localized pain should be assessed for myofascial and neuropathic pain in the muscles and soft tissues in addition to the joints
.

• X-ray examinations are performed to understand cartilage erosion and inflammatory changes, and MRI examinations are required if radiculopathy or plexopathy is suspected, or new headaches are present
  .
  

X-ray examinations are performed to understand cartilage erosion and inflammatory changes, and MRI examinations are required if radiculopathy or plexopathy is suspected, or new headaches are present
.

• In patients with suspected neuropathic damage, tests such as electromyography and nerve conduction velocity should be performed
  .
  

In patients with suspected neuropathic damage, tests such as electromyography and nerve conduction velocity should be performed
.

• Because patients with chronic pain are often accompanied by varying degrees of anxiety or depression, psychological and mental status should be evaluated in such patients
  .
  

Because patients with chronic pain are often accompanied by varying degrees of anxiety or depression, psychological and mental status should be evaluated in such patients
.

2.
4 ways to manage RA pain

The principles of treatment are ① clear diagnosis and active treatment of the primary disease; ② simultaneous pathological treatment and psychological adjustment; ③ comprehensive treatment with multiple methods
.
Treatment methods mainly include non-drug therapy, drug therapy, interventional therapy and surgery
.

non-drug treatment

Mainly through psychological intervention, self-regulation measures (such as acupuncture , yoga, biofeedback therapy) to relieve pain
.

medical treatement

a.
Non-steroidal anti-inflammatory drugs (NSAIDs): they are the most well-documented and commonly used analgesics, and the first choice for pain treatment in patients with RA
.
Commonly used NSAIDs are acetaminophen, indomethacin, naproxen, ibuprofen, diclofenac sodium, flurbiprofen axetil, ketorolac, loxoprofen sodium or a combination of these drugs
.
Or use selective COX-2 inhibitors including celecoxib, erecoxib,
etc.

Topical NSAIDs and intravenous injection preparations are easy to use and are one of the most commonly used analgesics in clinical practice
.
Long-term use of NSAIDs should be noted that it may increase the risk of gastrointestinal ulcers, bleeding, cardiovascular adverse events, etc.
; patients with a history of gastrointestinal ulcers, coagulation disorders and renal failure should be used with caution
.
If long-term medication is required, gastric mucosal protective agents and proton pump inhibitors can be supplemented at the same time
.

b.
Opioid analgesics: Opioids are mainly suitable for patients with moderate to severe chronic pain who use NSAIDs and other poor efficacy, or cannot tolerate the adverse reactions of gastrointestinal tract
caused by NSAIDs .
Common drugs include strong opioids morphine, oxycodone, tramadol, fentanyl, buprenorphine, etc.
, weak opioids codeine, tramadol,
etc.

Opioids are administered in a variety of ways, including oral, injection, and patches (such as buprenorphine transdermal patches, fentanyl transdermal patches, etc.
)
.
Adverse reactions include nausea, vomiting, drowsiness, respiratory depression, constipation, etc.
Long-term use may lead to addiction
.
When using opioids in elderly patients, attention should be paid to the lowest effective dose, and slow-release dosage forms or transdermal patches should be used as much as possible
.

c.
Anticonvulsants and antidepressants: Anticonvulsants are mainly used in the treatment of chronic neuropathic pain and fibromyalgia, especially for neuropathic pain of burning, tearing and numbing pain
.
Commonly used clinical drugs include pregabalin, carbamazepine, gabapentin, topiramate, zonisamide, lamotrigine, oxcarbazepine, levetiracetam,
etc.

interventional therapy

If the patient develops radicular pain, interventional therapy may be considered, including intra-articular injection of the sacroiliac joint, medial branch block, and radiofrequency ablation
.

Surgical treatment

Arthroscopic synovectomy can be performed to slow disease progression and chronic pain in RA patients
.
The timing of surgery is for patients with joint pain, no obvious structural damage, and ineffective drug treatment for more than 6 months
.
However, it is not recommended for patients with advanced RA with a high failure rate
.

For joints with moderate to severe destruction of the articular cartilage and subchondral bone, total joint arthroplasty can result in resolution of joint pain, correction of deformity, and improvement in function
.

3.
Relieve joint pain and strengthen comprehensive management

In addition to considering laboratory indicators such as the number of swollen joints, erythrocyte sedimentation rate, C-reactive protein, and extra-articular involvement, joint pain is also an important consideration and a predictor of the progression of joint damage in the selection of RA treatment options
.

Traditional disease-modifying antirheumatic drug therapy (DMARDs) should be started as soon as possible in RA patients
.
It is recommended that methotrexate alone is the first choice, and the efficacy should be evaluated after 1-3 months of methotrexate treatment.
For patients who have not reached the standard of treatment and have poor prognostic factors, methotrexate combined with biologics DMARDs can be considered.
Necrosis factor-α (TNF-α) inhibitors are currently well-documented and widely used biological DMARDs for the treatment of RA, including adalimumab, etanercept, and infliximab
.

During the treatment process, patients need to emphasize standardized, long-term treatment, monitoring and life>
.