Pain management in rheumatological diseases: manifestations and treatments

By Cristiano Antonino On May 15, 2023

Pain in rheumatological diseases: manifestations and treatments. Rheumatic diseases, in Italy, affect more than 5 million people (especially women over 65 years of age) and manifest themselves in most cases with pains in the locomotor system (joints and muscles), roughly distinct in those secondary to arthritis, osteoarthritis and fibromyalgia

Understand rheumatological diseases

It is very important to understand if there is an inflammatory pathology or a degenerative pathology at the base of musculoskeletal pain and to exclude that other organs (for example heart and lungs) are also affected in addition to joints and muscles.

Delaying diagnosis and treatment can lead to a worsening of painful symptoms and significantly affect the quality of life of patients, reaching, in the most aggressive cases, compromising the functionality of the structures involved.

Pain – the main symptom of rheumatological diseases

The main symptom of rheumatological diseases is pain, which can affect the patient at an articular, muscular and/or skeletal level, affecting both the limbs and the spine with a symmetrical or asymmetrical pattern.

The pain caused by rheumatological diseases has variable intensity depending on the degree of inflammation present, but also on the degree of consequent joint degeneration.

Arthritis: A Morning Pain

When it comes to arthritis, the most common of which is rheumatoid arthritis, the pain is typically inflammatory, i.e. it is characterized by worsening at rest, at night and in the early hours of the morning and is accompanied by significant stiffness upon awakening and / or swelling of the affected joint sites.

These clinical signs are an expression of an inflammation which, in addition to the joints, can also involve the whole body of the patient, which is why arthritis can be defined as a “systemic” disease.

Women between the ages of 30 and 50 are generally affected, but the disease can strike at any age; although the origin of these chronic inflammatory conditions is not fully understood, we now know that both predisposing genetic factors and environmental and lifestyle factors contribute.

When it comes to arthritis, it is important to recognize its type during the diagnosis, so as to be able to guarantee the patient the most appropriate treatment to alleviate the painful symptoms and stop the progression of any joint damage.

Today, the new therapeutic options allow not only the improvement of pain and inflammation control, but also the achievement of a satisfactory quality of life and the normal performance of usual daily activities.

Osteoarthritis: a long-lasting pain

In osteoarthritis, however, the painful symptomatology has different characteristics: it usually improves with rest, is not associated with frank episodes of joint swelling and is accompanied by stiffness upon awakening which generally does not exceed 30 minutes.

Being linked to the wear and tear of the joint, osteoarthritis has a chronic course and is more common with increasing age, especially in women and in subjects with known familiarity.

To worsen the degenerative process is the continuous use or overload of the affected area; for this reason, among the risk factors, in addition to age, we find body weight and the performance of repetitive and heavy work activities.

The vertebral column, especially in the cervical and lumbar regions, the hips, knees, and hands are most involved.

To date, there are no effective medical therapies to prevent or slow down the progression of the arthritic process and the drugs that are used are mainly aimed at pain control.

In addition to analgesics taken systemically, local infiltrative therapies based on cortisone and above all hyaluronic acid can help; however in the more advanced stages, prosthetic surgery is the only decisive alternative.

In addition to these medical-surgical approaches, it is important to associate an adequate lifestyle, with particular attention to body weight and the performance of physical activities aimed at strengthening the muscles.

Psoriatic arthritis and gout

A form of arthritis other than rheumatoid is psoriatic arthritis, which affects patients with psoriasis or a family history of psoriasis in first-degree relatives, particularly between the ages of 30 and 50.

Unlike rheumatoid arthritis, this disease primarily affects the large joints of the lower limbs (e.g. knees and ankles) and the spine with a generally asymmetrical pattern.

Also in the case of psoriatic arthritis the hallmark symptom is pain, associated with stiffness and swelling.

In addition to the joints, tendon structures and around the joint can also be affected as occurs in the case of dactylitis, typical manifestations of psoriatic arthritis in which the pain is associated with swelling of an entire finger and/or toe, with appearance called “sausage”; another typical expression of psoriatic arthritis is enthesitis or the inflammation of the point of “anchorage” of tendons and/or ligaments to the bone.

While rheumatoid arthritis rarely affects the spine, inflammation of the joints of the vertebrae (spondylitis) or the sacroiliac joints (sacroiliitis) is not uncommon in psoriatic arthritis, accompanied by typical low back pain.

Gout is a form of arthritis defined as the “microcrystalline” type as it develops in those joints where crystals are deposited due to excess uric acid in the blood.

It is an acute and very rapid onset arthritis, with marked pain, especially at night, associated with swelling and redness of the affected joint (in most cases the big toe).

The severe pain caused by gout is often caused by the simple contact with the sheet and therefore prevents those who suffer from restful sleep.

In case of acute episodes, non-steroidal anti-inflammatory drugs and colchicine are used to mitigate the painful symptoms and extinguish the inflammatory process; however, the treatment of this form of arthritis is also based on the prevention of acute attacks with the maintenance of low levels of uric acid in the blood through targeted drugs, controlled diets with reduced protein intake and the correction of harmful lifestyles (e.g. alcohol intake, sedentary life, low water intake).

Fibromyalgia: Muscle pain is the main symptom

Among the pathologies characterized by persistent and widespread muscle pain is fibromyalgia, a disease for which, unfortunately, there is still no cure and which, alongside the painful symptoms, are associated with other manifestations including sleep disturbances, chronic fatigue and alterations of memory and humor.

Fibromyalgia particularly affects adult women and its causes are not yet certain: in fact, it can manifest itself either following a single physical or psychological triggering trauma, or gradually.

At the basis of this disease there seems to be an increased cerebral sensitivity to painful stimuli with consequent exaggerated responses and evocation of pain even for minimal pressure exerted.

The key symptom is in fact the dull, constant and widespread pain at the musculoskeletal level, with no other associated signs of inflammation.

Pain can be evoked by exerting a certain pressure on certain points of the body, the so-called tender points; the latter can direct the correct diagnosis, together with the complete negativity of laboratory and radiographic tests.

The treatment of this pathology involves the use of analgesics, antidepressants and muscle relaxants; lifestyle changes and associated targeted physical therapies are also required.

Medicines and lifestyle against pain in rheumatological diseases

Today the treatment of rheumatic diseases is based both on the use of drugs and on behavioral interventions aimed at improving the lifestyle, allowing the patient to return to normal daily activities.

The drugs used are divided into symptomatic, mainly consisting of analgesics and non-steroidal anti-inflammatory drugs, and “background” drugs capable of modifying the natural history of the disease.

These include glucocorticoids, immunosuppressive drugs, and biologics.

In some cases, if the pathology has resulted in joint damage with deformity and functional limitation, it may be necessary to resort to surgical treatment.

Patients affected by rheumatic diseases must also pay particular attention to lifestyle, which can help improve symptoms and reduce the degree of inflammation.

It is important to maintain a balanced diet, practice physical activity regularly, modulating the intensity according to your state of health, and reduce stress factors as much as possible.

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