Pain in systemic inflammatory rheumatic diseases

Fabiola Atzeni, Ignazio Francesco Masala, Fausto Salaffi, Manuela Di Franco, Roberto Casale, Piercarlo Sarzi-Puttini

Research output: Contribution to journalArticlepeer-review


Abstract 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.

Original languageEnglish
Article number1131
Pages (from-to)42-52
Number of pages11
JournalBest Practice and Research: Clinical Rheumatology
Issue number1
Publication statusPublished - Feb 1 2015


  • Arthritides
  • Chronic pain
  • Inflammation
  • Pharmacological therapy

ASJC Scopus subject areas

  • Rheumatology


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