IntroductionIncreasing evidence indicates that features suggestive of neuropathic pain may also be present in patients with common rheumatic conditions. The objective of this study was to examine neuropathic-like pain symptoms and associated factors in patients with rheumatoid arthritis.MethodsWe used the painDETECT screening tool to identify possible or likely neuropathic pain in 159 outpatients with rheumatoid arthritis. Patients additionally completed other self-reported measures, while clinical measures were assessed to calculate the 28-joint Disease Activity Score. Univariate analyses and multivariable logistic regression were used to identify factors associated with neuropathic pain features.ResultsAccording to the painDETECT, 27 patients (17.0 %) were classified as having likely neuropathic pain and 34 patients (21.4 %) as having possible neuropathic pain. Besides reporting more severe pain, patients with likely or possible neuropathic pain were more likely to meet the diagnostic criteria for fibromyalgia, to use analgesics, and to have more tender joints and a worse physical and mental health status as measured by the 36-item Short-Form health survey. In multivariable analysis, physical (P < 0.001) and mental health status (P = 0.006) remained significantly associated with neuropathic pain features, even after controlling for pain severity.ConclusionsThese findings suggest that a sizeable proportion of patients with relatively well-controlled rheumatoid arthritis report symptoms suggestive of neuropathic pain. Neuropathic-like pain symptoms are independently associated with worse self-reported physical and mental health.

BackgroundPain control in rheumatoid arthritis (RA) is often inadequate and clinically significant pain persists in a substantial proportion of patients, even when inflammation appears to be well controlled. This suggests that inflammation or subsequent joint damage might not be the only factor causing pain in RA. Accumulating evidence suggests that features of neuropathic pain may also be present in patients with rheumatic pain conditions.ObjectivesTo estimate the prevalence and factors associated with neuropathic-like pain symptoms in patients with rheumatoid arthritis (RA).MethodsA cross-sectional sample of 159 RA patients completed the painDETECT questionnaire along with other self-reported measures before their visit to the rheumatology outpatient clinic. Univariate analyses and multivariable logistic regression were used to identify factors associated with neuropathic pain features.ResultsThe large majority of patients (88%) were in remission or had low disease activity, but 44% of the patients continued to report clinically significant pain. According to the painDETECT, 27 patients (17.0%) were classified as having likely neuropathic pain and 34 patients (21.4%) as having possible neuropathic pain. Besides reporting more intense pain, patients with likely or possible neuropathic pain were more likely to meet the diagnostic criteria for fibromyalgia, to use analgesics, and to have more tender joints and worse physical and mental health status as measured by the SF-36. In multivariable analysis, physical (P<0.001) and mental health status (P=0.006) remained significantly associated with neuropathic pain features, even after controlling for pain severity.ConclusionsNeuropathic-like pain symptoms are present in a substantial number of patients with RA and are associated with worse physical and mental health. These symptoms may represent central sensitization and underscore the need for further research and screening of pain mechanisms in RA patients.Disclosure of InterestNone declared