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    Mechanisms, impact and management of pain in rheumatoid arthritis

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    Author
    Walsh, David A
    Keyword
    Physiological aspects
    Rheumatoid arthritis
    Pain
    Pain management
    Methods
    Date
    2014-10
    
    Metadata
    Show full item record
    Publisher's URL
    https://www.nature.com/articles/nrrheum.2014.64
    Abstract
    People with rheumatoid arthritis (RA) identify pain as their most important symptom, one that often persists despite optimal control of inflammatory disease. RA pain arises from multiple mechanisms, involving inflammation, peripheral and central pain processing and, with disease progression, structural change within the joint. Consequently, RA pain has a wide range of characteristics-constant or intermittent, localized or widespread-and is often associated with psychological distress and fatigue. Dominant pain mechanisms in an individual are identified by critical evaluation of clinical symptoms and signs, and by laboratory and imaging tests. Understanding these mechanisms is essential for effective management, although evidence from preclinical models should be interpreted with caution. A range of pharmacological analgesic and immunomodulatory agents, psychological interventions and surgery may help manage RA pain. Pain contributes importantly to the clinical assessment of inflammatory disease activity, and noninflammatory components of RA pain should be considered when gauging eligibility for or response to biologic agents. Further randomized controlled trials are required to determine the optimal usage of analgesics in RA, and novel agents with greater efficacy and lower propensity for adverse events are urgently needed. Meanwhile, targeted use of existing treatments could reduce pain in people with RA.
    Citation
    Walsh, D. A. and McWilliams, D. F. (2014) ‘Mechanisms, impact and management of pain in rheumatoid arthritis’, Nature Reviews Rheumatology, 10(10), p. 581
    Publisher
    Nature Reviews Rheumatology
    Type
    Article
    URI
    http://hdl.handle.net/20.500.12904/15562
    Collections
    Rheumatology

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