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Pain & RA Disease Activity: When They Don’t Align

Rheumatoid Arthritis & Pain Management

Pain can be a part of life with RA. Even if your therapy is working and you’re in remission, you can still experience pain: More than 10% of people with RA who had achieved one standard definition of disease remission still reported persistent pain in one study¹

Why Pain Matters

Pain has a major effect on your quality of life, relationships, job, physical function, and social life. Chronic pain can keep you from doing the activities you enjoy, and it can lead to other health problems too, like poor sleep and depression. Treating RA pain is very important—more than two-thirds of people with RA rate their pain as the number one symptom they would like to address with therapy².  

Why RA Pain Can Stick Around

In the early stages of RA, joint pain is usually due to synovitis, or inflammation of the soft tissues that line and cushion your joints. Synovitis pain often gets better with prompt treatment. But even with treatment that lowers your disease activity, people with RA can still have pain from other causes, such as:

  • Weakened muscles that can’t support joints, leading to soreness or painful joint injuries
  • Overuse of joints from strenuous physical activity.  
  • Inflamed tendons (tendonitis) or ligaments, the soft tissues that connect bones and muscles at joints. 
  • Bursitis, inflamed tissue sacs that cushion joints like your hips or shoulders.
  • Osteoarthritis, a different type of arthritis where cartilage and bone break down, that’s more common with aging and long-term, repetitive use of your joints. 

Find the Cause of Your Pain

If you and your doctor can identify the reason for your pain, medications and modifying your activities can help you get pain under control. If high disease activity is the reason for your joint pain, treatments that lower it and keep it low or in remission can help control symptoms like joint pain³

What about pain medications that don’t lower disease activity, but just treat pain? Some pain medications have serious risks, including opioid tolerance and addiction, and NSAIDs’ gastrointestinal and cardiovascular side effects. Nondrug pain relief strategies like exercise are safer, relieve pain, and can help you function better too⁴

Pain and Disease Activity

When you’re having a flare, your pain is due to a spike in disease activity. You may experience other joint symptoms too, like swelling, redness, heat, stiffness, and lack of mobility. If your disease activity stays elevated, you’re at risk for joint erosions and damage. 

That’s why it’s so important to contact your rheumatologist right away if you have severe pain or any other signs that indicate a flare-up of disease activity. You may need a short-term course of steroids or other treatment modifications to relieve this unusually high inflammation and pain. 

Pain Even When RA is Controlled

Even if your disease activity is under control, some people with RA still experience some pain. 

In a 2011 study of 865 people with RA, almost 12% of people who had reached one standard of remission, DAS28-CRP, still had clinically significant levels of pain. However, people who treated their RA disease activity to reach a newer, more aggressive criteria for remission did not report pain1.

Pain isn’t always a sign of high RA disease activity. To find out why you’re in pain, see your rheumatologist for a physical exam and tests, including Vectra®, an advanced blood test that objectively measures inflammation caused by RA. Your Vectra Score gives you one number between 1-100 to tell you if your inflammation is elevated and if you are at risk for future joint damage. If your disease activity is high, your doctor can prescribe treatments to get it under control again. But if your disease activity isn’t high, you may have pain from another cause.

What You Can Do About Pain

Once you know the cause of your pain, you and your doctor can talk about effective options to treat it. Medications aren’t your only option; other things to consider include: 

  • Physical therapy can show you how to properly move your joint to relieve pain, suggest exercises, and show you how to use heat or cold therapies to ease pain. Your physical therapist can fit you for a splint to ease pain in your hands and wrists too.
  • Non-drug therapies for joint pain include heat and cold, but also more supportive footwear, exercises that build stronger muscles to support your joints, touch therapies like massage or acupuncture, soothing aromatherapy, and mind-body techniques like hypnosis or meditation.
  • Joint replacement surgery: If your joint is damaged, replacing it with an artificial joint may relieve pain and restore function. If joint replacement is right for you, your rheumatologist can refer you to an orthopedic surgeon. 

If your RA disease activity is well controlled, but you still have joint pain, talk to your rheumatologist. Together, you can come up with a plan to manage it so you can get back to your normal activities and enjoy your life! Between appointments, track your pain and other symptoms using the myVectra™ patient portal. You can log in or create an account at https://my.vectrascore.com/login. At each appointment, review your symptoms, pain, and most recent Vectra Score to see if your disease activity has changed over time—this helps you see if your current treatment plan is working well to prevent future joint damage.

 

Sources:

  1. Lee YC, Cui J, Lu B, et al. “Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: an longitudinal observational study.” Arthritis Res Ther. 2011;13(3):R83.
  2. Duenas M, Ojeda B, Salazar A, et al. “A review of chronic pain impact on patients, their social environment, and the healthcare system.” J Pain Res. 2016;9:457-67.
  3. Solomon D, Bitton A, Katz J, et al. “Treat to Target in Rheumatoid Arthritis: Fact, Fiction or Hypothesis?” Arthritis Rheumatol. 2014 Apr;66(4):775-782.
  4. Geneen L, Moore RA, Clarke C, et al. “Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews.” Cochrane Database Syst Rev. 2017 Apr;2017(4):CD011279.
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