Effect and treatment of chronic pain in inflammatory arthritis.

Pain is the most common reason patients with inflammatory arthritis see a rheumatologist. Patients consistently rate pain as one of their highest priorities, and pain is the single most important determinant of patient global assessment of disease activity. Although pain is commonly interpreted as a marker of inflammation, the correlation between pain intensity and measures of peripheral inflammation is imperfect. The prevalence of chronic, non-inflammatory pain syndromes such as fibromyalgia is higher among patients with inflammatory arthritis than in the general population. Inflammatory arthritis patients with fibromyalgia have higher measures of disease activity and lower quality of life than inflammatory patients who do not have fibromyalgia. This review article focuses on current literature involving the effects of pain on disease assessment and quality of life for patients with inflammatory arthritis. It also reviews non-pharmacologic and pharmacologic options for treatment of pain for patients with inflammatory arthritis, focusing on the implications of comorbidities and concurrent disease-modifying antirheumatic drug therapy. Although several studies have examined the effects of reducing inflammation for patients with inflammatory arthritis, very few clinical trials have examined the safety and efficacy of treatment directed specifically towards pain pathways. Most studies have been small, have focused on rheumatoid arthritis or mixed populations (e.g., rheumatoid arthritis plus osteoarthritis), and have been at high risk of bias. Larger, longitudinal studies are needed to examine the mechanisms of pain in inflammatory arthritis and to determine the safety and efficacy of analgesic medications in this specific patient population.

疼痛是炎性关节炎患者看风湿病医生最常见的原因。患者一直将疼痛列为他们最优先关注的问题之一，并且疼痛是患者对疾病活动总体评估的最重要的单一决定因素。尽管疼痛通常被视为炎症的一个标志，但疼痛强度与外周炎症指标之间的相关性并不完美。纤维肌痛等慢性非炎症性疼痛综合征在炎性关节炎患者中的患病率高于普通人群。患有纤维肌痛的炎性关节炎患者比没有纤维肌痛的炎性患者有更高的疾病活动指标和更低的生活质量。这篇综述文章聚焦于涉及疼痛对炎性关节炎患者疾病评估和生活质量影响的当前文献。它还回顾了炎性关节炎患者疼痛治疗的非药物和药物选择，重点关注合并症以及同时进行的改善病情抗风湿药物治疗的影响。尽管有几项研究已经检验了减轻炎症对炎性关节炎患者的影响，但很少有临床试验专门针对疼痛通路治疗的安全性和有效性进行检验。大多数研究规模较小，聚焦于类风湿关节炎或混合人群（例如类风湿关节炎加骨关节炎），并且存在高偏倚风险。需要更大规模的纵向研究来检验炎性关节炎中疼痛的机制，并确定镇痛药在这一特定患者群体中的安全性和有效性。