Controlled Rheumatoid Arthritis May Not Mean Zero Pain

Medically reviewed in April 2022

If your rheumatoid arthritis is under control, you should be pain-free, right? Maybe not. Nearly half of people who are being treated for RA and who have little or no inflammation in their joints continue to suffer pain that affects their quality of life. What’s going on?

It could be a different kind of pain, according to a small study published in 2015.

Researchers from University of Twente in Enschede, the Netherlands, surveyed 159 people with RA about their ongoing pain symptoms. Though 88% of the participants were in remission or had low disease activity, many of them said they continued to suffer from pain. Specifically, 17% likely had a type of pain called neuropathic (nerve) pain, and another 21% possibly had it.

The usual aching and gnawing pain of RA is caused by inflammation, but nerve pain is different. Nerve pain feels like burning, pressure, even prickling or electric shocks. Scientists it happens when the nervous system becomes unusually sensitive, and it can continue even when there is no longer any injury or damage to the joints. It’s the same type of pain that affects people with conditions like fibromyalgia.

Most importantly, while “disease-modifying” drugs and biologics work so well at treating RA inflammation, they don’t help with nerve pain. Doctors usually manage nerve pain with other medications, including antidepressants, pain relievers and certain epilespy drugs.

Don’t suffer in silence
If you’re still experiencing pain, though, don’t assume it’s normal and that you have to tough it out. Tell your doctor. Make sure to describe in detail what it feels like, to help your doctor sort out whether it’s nerve pain or inflammation. She may want to change your prescriptions, or up your dosages.

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