Residual Pain in the Context of Selecting and Switching Biologic Therapy in Inflammatory Rheumatic Diseases

Abstract

For many years, inflammatory rheumatic diseases (IRDs) represented a source of disappointment in medical care caused by the mediocre efficacy of the available treatments. Some of these diseases, like Rheumatoid Arthritis (RA) or Ankylosing Spondylitis (AS), caused fear in the general population, especially due to associated joint deformities and subsequent disabilities. However, in the last 20 years, a new successful class of antirheumatic drugs has become available: biologic Disease-Modifying Antirheumatic Drugs (bDMARDs). Due to this innovative treatment, the days are over when joint and spine deformities defined the condition of a person with RA or AS. Nonetheless, expectations are higher today, and other clinical problems, (not entirely solved by bDMARDs), seem to drive the drug selection during the span of rheumatic diseases. Most of these issues are covered by the term “unmet needs.” One of the most intriguing of such needs is the residual pain (RP) in patients that are otherwise in the biological remission of the disease. Present in a significant proportion of the patients that enter remission status, RP is poorly understood and managed. In recent years, new data has become available in this area and new conceptual clarifications have occurred. In this review, we explain the various nature of RP and the necessity of treatment diversification in such situations. All in all, we believe this condition is far more complex than simple pain and includes other clinical aspects, too (like fatigue or mood changes) so the terms Post-Remission Syndrome (PRS), and PRS pain might be more appropriate.

Activity limitation and participation restriction in Osteoarthritis and Rheumatoid arthritis: findings based on the National Health and Nutritional Examination Survey

“…A possible reason behind this finding could be linked with reduced HRQoL as activity limitations, other medical conditions and social factors affect the individual’s quality of life [ 36 ]. Another possible explanation for this finding is that rheumatic diseases such as RA, causes fear in the general population, especially due to associated joint deformities and subsequent disabilities [ 37 ], as a result majority feel insecure in terms of physical, emotional and social well-being. Poor/fair health condition was highly reported by individuals with difficulties in attending social events, going out to movies, performing leisure activities, lifting or carrying things, preparing meals, standing for long periods difficulty, sitting for long periods difficulty, walking for a quarter mile difficulty and walking up ten steps difficulty ( p < 0.05); of which the highest odds were at leisure activity at home difficulty followed by attending social event and walking for a quarter mile.…”

Dynamics of patient reported outcomes during the use various biological disease-modifying antirheumatic drugs for rheumatoid arthritis

“…Следует отметить, что боль существенно реже отмечается у лиц, достигших ремиссии по CDAI, SDAI и особенно по жестким критериям Американской коллегии ревматологов/Европейского альянса ревматологических ассоциаций (ACR/ EULAR, American College of Rheumatology/European Alliance of Associations for Rheumatology) (Boolean) [13][14][15]. Кроме того, у части пациентов, находящихся в состоянии ремиссии, сохраняются функциональные нарушения (HAQ>0,5), а также ощущение усталости или повышенной утомляемости [17,18]. Весьма показательно исследование I. Navarro-Millán и соавт.…”

Baricitinib ameliorates inflammatory and neuropathic pain in collagen antibody-induced arthritis mice by modulating the IL-6/JAK/STAT3 pathway and CSF-1 expression in dorsal root ganglion neurons

“…The management of RA has improved dramatically with the development of antibody-based drugs against TNF and IL-6 (known as biological disease-modifying antirheumatic drugs, DMARDs) and JAK inhibitors, in addition to methotrexate. However, residual pain continues to be observed in a large proportion of patients who are experiencing biological remission of RA [ 4 ]. It remains difficult to clearly assess and classify pain, although recent findings suggest the presence of neuropathic pain in rheumatic conditions [ 4 ].…”