Evaluation of the Effect of Neuropathic Pain on Quality of Life in Rheumatoid Arthritis Patients
Condition: Rheumatoid Arthritis; Neuropathic Pain
MeSH terms: Arthritis; Arthritis, Rheumatoid; Neuralgia
Study type: Observational

Summary: 
      Rheumatoid arthritis is a chronic inflammatory disease that mainly affects the joint
      synovium. Rheumatoid arthritis patients define pain as their major symptom and the most
      important reason for applying to a healthcare institution. Approximately 70% of rheumatoid
      arthritis patients state that improvement in their pain compared to other symptoms of the
      disease is their priority. Pain in rheumatoid arthritis patients is also important as the
      disease affects approximately 0.5-1% of patients worldwide.

      Although pain in rheumatoid arthritis patients can be persistent or intermittent, localized
      or widespread, it has often been associated with fatigue and psychosocial stress. Although
      nociceptive pain,defined as 'gnawing' or 'aching', is frequently observed in rheumatoid
      arthritis patients, typical neuropathic pain,such as 'burning' or 'itching', can be observed
      in some RA patients. It is thought that neuropathic pain may occur as a result of lesions or
      disease affecting the somatosensorial nervous system. Neuropathic pain can occur with little
      or no stimulus, and its symptoms are abnormal sensations such as hyperalgesia and allodynia.

      The diagnosis and treatment of neuropathic pain in rheumatoid arthritis patients is important
      because neuropathic pain does not decrease with traditional disease-modifying
      anti-inflammatory drugs used in rheumatoid arthritis and causes a decrease in quality of
      life. In order to distinguish neuropathic pain from chronic pain, methods based on defining
      the quality of pain are often used. Some of these methods are; The McGill Pain Questionnaire,
      PainDETECT, RAPS (Rheumatoid Arthritis Pain Scale), VAS (visual analog scale), AIMS
      (Arthritis Impact Scale), EQ-5D (European Quality of Life Assessment and Pain Assessment
      Questionnaire).

      The diagnosis and treatment of neuropathic pain in rheumatoid arthritis patients is important
      because neuropathic pain does not decrease with traditional disease-modifying
      anti-inflammatory drugs used in rheumatoid arthritis and causes a decrease in quality of
      life.
    

Detailed description: 
      Rheumatoid arthritis is a chronic inflammatory disease that mainly affects the joint
      synovium. Rheumatoid arthritis patients define pain as their major symptom and the most
      important reason for applying to a healthcare institution. Approximately 70% of rheumatoid
      arthritis patients state that improvement in their pain compared to other symptoms of the
      disease is their priority. Pain in rheumatoid arthritis patients is also important as the
      disease affects approximately 0.5-1% of patients worldwide.

      Synovial inflammation, which can lead to joint deformity by causing cartilage and bone
      destruction, is the main pathophysiological mechanism in rheumatoid arthritis, and therefore
      the main cause of pain in rheumatoid arthritis patients is thought to be nociceptive.
      Although pain in rheumatoid arthritis was previously associated with tissue damage and
      inflammatory processes in the joints, accumulated knowledge shows that peripheral
      inflammation, disease progression, structural and neurochemical changes in the joints and
      sensorial system, and central pain process mechanisms may also play a role in these
      rheumatoid arthritis patients.

      Although pain in rheumatoid arthritis patients can be persistent or intermittent, localized
      or widespread, it has often been associated with fatigue and psychosocial stress. Although
      nociceptive pain, defined as 'gnawing' or 'aching', is frequently observed in rheumatoid
      arthritis patients, typical neuropathic pain, such as 'burning' or 'itching', can be observed
      in some RA patients. It is thought that neuropathic pain may occur as a result of lesions or
      disease affecting the somatosensorial nervous system. Neuropathic pain can occur with little
      or no stimulus, and its symptoms are abnormal sensations such as hyperalgesia and allodynia.

      Although the frequency of neuropathic pain in rheumatoid arthritis patients varies in various
      clinical studies, it is approximately 20.7-30%. The diagnosis and treatment of neuropathic
      pain in rheumatoid arthritis patients is important because neuropathic pain does not decrease
      with traditional disease-modifying anti-inflammatory drugs used in rheumatoid arthritis and
      causes a decrease in quality of life. To distinguish neuropathic pain from chronic pain,
      methods based on defining the quality of pain are often used. Some of these methods are; The
      McGill Pain Questionnaire, PainDETECT, RAPS (Rheumatoid Arthritis Pain Scale), VAS (visual
      analogue scale), AIMS (Arthritis Impact Scale), EQ-5D (European Quality of Life Assessment
      and Pain Assessment Questionnaire).

      Although non-steroidal anti-inflammatory drugs(NSAIDs) are used for pain in rheumatoid
      arthritis, it is not suitable for long-term disease control. It is important to start the use
      of disease-modifying agents (DMARDs) in the early period in patients.

      Analgesic agents such as NSAIDs, acetaminophen, and opioids are used for pain in rheumatoid
      arthritis patients. However, some side effects of these drugs frequently limit their usage.
      Long-term opioid use in pain treatment is not recommended due to its side effects such as
      constipation, nausea and vomiting, and should be used with careful monitoring when necessary.
      Other drugs such as tricyclic antidepressants and topical capsaicin have been used in
      randomized controlled trials for pain management in RA with limited success.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Rheumatoid arthritis patients
      
Keywords: rheumatoid arthritis; neuropathic pain; pain in rheumatoid arthritis