If your rheumatoid arthritis (RA) is under control, you should be pain-free, right? Maybe not.
Many people who are being treated for RA and have little or no inflammation in their joints continue to have pain that affects their quality of life. In fact, a small 2018 study published in BMC Rheumatology found that when healthcare providers (HCPs) told RA patients they were in remission, one-third of those patients didn’t agree. They still were still in pain.
Why? It could have been a different kind of pain. The usual aching and gnawing pain of RA is caused by inflammation. But RA is also linked to other kinds of pain, which may be present even during treatment.
What to know about non-inflammatory RA pain
There are three main types of RA pain. Someone with RA might experience two or three types at the same time. This is called mixed pain.
- Nociceptive pain is caused by tissue damage. In RA, damage is usually caused by inflammation. It may feel like throbbing, aching, stiffness, or tenderness.
- Neuropathic (nerve) pain is caused by damage to a nerve. It may feel like burning, prickling, tingling, or piercing.
- Nociplastic pain is pain not caused by tissue damage or nerve damage. It may feel like pain spread throughout the body.
Nociplastic pain can have different sources. It can arise from other health conditions that cause pain of the central nervous system. This includes fibromyalgia, a chronic pain disorder that’s much more common in people with RA than people without RA.
Nociplastic pain is also linked to an enhanced perception of pain. When a person with RA is in remission, they may still sleep poorly or have anxiety or depression. As a result, they may be less able to cope with pain, and so the experience of it is worse.
It’s also possible that RA itself changes how the nervous system processes pain or causes certain neurons to become especially sensitive. This is called central sensitization.
Different treatments for inflammatory pain and nerve pain
It’s important for HCPs to conduct tests, imaging, and careful evaluations to determine the source of RA pain, so it can be effectively treated. While anti-inflammatory drugs, disease-modifying drugs, and biologics work well at treating RA inflammation, they might not be effective for other types of pain.
HCPs often manage nerve and nociplastic pain with other medications, which may include antidepressants, pain relievers, topical treatments, and certain antiseizure drugs. Physical therapy helps many people, as well.
You can also take steps at home to help ease all types of RA pain. These include:
- Eating a diet rich in veggies, fruits, whole grains, and lean proteins
- Getting sufficient physical activity
- Trying a mind-body exercise, like yoga or tai chi
- Looking into psychological counseling
- Quitting smoking
- Limiting alcohol
Don’t be silent
If you still experience pain even though you’re being treated for RA, don’t assume it’s normal or that you must bear it quietly. Tell an HCP. Make sure to describe in detail what it feels like, to help your HCP sort out whether it’s nerve pain, inflammation, or another type of pain. They may want to change your prescriptions or increase your dosages.
Sources: Turk SA, Rasch LA, van Schaardenburg D, ... + 9
- Turk SA, Rasch LA, van Schaardenburg D, Lems WF, et al. Pain, sleep and emotional well-being explain the lack of agreement between physician- and patient-perceived remission in early rheumatoid arthritis. BMC Rheumatol. 2018 Jun 26;2:16.
- Das D, Choy E. Non-inflammatory pain in inflammatory arthritis. Rheumatology (Oxford). 2023;62(7):2360-2365.
- Arthritis Foundation. Types of Pain and the Body. Page last updated October 20, 2022
- Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, et al. Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet. 2021 May 29;397(10289):2098-2110. .
- Khot S, Tackley G, et al. How to Distinguish Non-Inflammatory from Inflammatory Pain in RA?. Curr Rheumatol Rep. 2024;26(12):403-413.
- Motyl G, Krupka WM, et al. The problem of residual pain in the assessment of rheumatoid arthritis activity. Reumatologia. 2024;62(3):176-186.
- Lim DH. A Challenging Target: Persistent Pain During the Remission State in Rheumatoid Arthritis Patients. J Rheum Dis. 2023;30(1):1-2.
- Mary Anne Dunkin. Treatments for Rheumatoid Arthritis. Arthritis Foundation. June 12, 2022.
- Kelly Malcolm. What to do when pain lingers. University of Michigan Medicine. September 28, 2023.
- Cleveland Clinic. Neuropathic Pain. Page last reviewed November 13, 2023.
