• Juan Camilo Sánchez-Flórez, Daniela Seija-Butnaru, Edmundo Gónima Valero, Claudia Del Pilar Acosta Acosta, and Sebastian Amaya.
• Juan Camilo Sánchez-Flórez, MD, Resident, Pain Management and Palliative Care Department, Hospital Militar Central, Universidad de La Sabana - Instituto Nacional de Cancerología, Bogotá, Colombia; Daniela Seija-Butnaru, MD, Resident, Pain Management and Palliative Care Department, Hospital Militar Central, Universidad de La Sabana - Instituto Nacional de Cancerología, Bogotá, Colombia; Edmundo Gónima Valero, MD, Anesthesiologist, Fellow in Pain Management and Palliative Care Medicine, Chief of the Pain and Palliative Care Department, Hospital Militar Central, Bogotá, Colombia; Claudia del Pilar Acosta Acosta, MD, Anesthesiologist, Hospital Militar Central, Universidad del Rosario - Fundación Cardioinfantil, Bogotá, Colombia; Sebastian Amaya, MS, 6th Year Medical Student, Anesthesiology and Critical Care Interest Group UEB, Universidad El Bosque Colombian School of Medicine, Bogotá, Colombia.
• J Pain Palliat Care Pharmacother. 2021 Dec 1; 35 (4): 291-299.

AbstractRheumatoid Arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation and progressive deterioration of the joints, which generates pain and stiffness. The origin of this pain is multifactorial, with inflammation, secondary osteoarthritis, as well as central and peripheral sensitization playing important roles in the development. Up to 90.4% of RA patients visit a health professional for severe pain, and despite new therapies and sophisticated treatments, there are a limited number of options for analgesic management. We conducted a narrative review using the Medline and Pubmed search engines for articles in English and Spanish between 2000 and 2021, with the keywords "pain," "rheumatoid arthritis," "non-steroidal anti-inflammatory drugs" (NSAIDs), "opioids," "glucocorticoids," "disease modifying antirheumatic drugs" (DMARDs), "neuromodulators," "antidepressants," and "cannabinoids." The articles describing epidemiology, pathophysiological considerations and current treatments were selected after a screening process carried out by the authors. It was found that DMARDs are the fundamental basis of treatment, since the main mechanism of pain in this entity is inflammation. Nonetheless, a significant number of patients continue to have pain despite optimal treatment. The available evidence for pain management in RA is scarce, however, medications such as NSAIDs, topical capsaicin, weak opioids, and treatments such as joint infiltrations or surgical management, play an important role in its management. We believe more research efforts are needed to optimize analgesic treatment recommendations, however, based on the current existing evidence, we propose a stepwise algorithm in order to properly approach these cases.Key PointsRA is a systemic autoimmune disease characterized by chronic inflammation, in which the main symptom is pain.Pain in RA is multifactorial, with inflammation, secondary osteoarthritis, as well as central and peripheral sensitization playing determining roles.DMARDs are the mainstay of RA treatment, although many patients continue to experience pain despite optimal management.Medications such as glucocorticoids, NSAIDs, topical capsaicin, and weak opioids are key elements when achieving analgesia in RA.Other pharmacological groups such as neuromodulators, antidepressants, muscle relaxants and cannabinoids currently do not have enough evidence to be recommended.

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