Neuropathic Pain-Like Features in RA and SpA Patients Receiving Targeted Therapies

Between January 1 and March 1, 2026, researchers at the Department of Rheumatology of Mohammed V Military Teaching Hospital in Rabat, Morocco, conducted a cross-sectional study assessing 155 patients to determine the prevalence of neuropathic pain-like features in individuals with rheumatoid arthritis and spondyloarthritis receiving targeted therapies, Cureus reported.

Key Clinical Takeaways:

• Neuropathic pain-like features appeared in 24.4% of rheumatoid arthritis patients and 27.3% of spondyloarthritis patients on targeted treatments.
• Current pain intensity remained significantly associated with positive screening scores across both disease groups after multivariable adjustment.
• Screening tools such as the DN4 and painDETECT help identify non-inflammatory pain components that persist despite successful inflammation control.

Persistent joint pain remains a major clinical challenge even when biologic or targeted synthetic disease-modifying antirheumatic drugs effectively suppress inflammation. Chronic inflammatory rheumatic diseases impose a heavy global burden of disability and impaired quality of life. Because conventional treatments often leave patients with ongoing discomfort, researchers increasingly examine non-inflammatory contributors to pain, including neuropathic and nociplastic mechanisms. Screening questionnaires like the Douleur Neuropathique 4 and painDETECT help identify symptoms such as burning, tingling, and electric shock-like sensations, though these instruments do not establish a definitive neurological diagnosis.

The cross-sectional study evaluated 78 patients with rheumatoid arthritis and 77 patients with spondyloarthritis who had received targeted therapies for at least six months. Assessments utilized the DN4 and painDETECT questionnaires, alongside functional indices including the Health Assessment Questionnaire and the Bath Ankylosing Spondylitis Functional Index. A DN4 score of four or higher identified neuropathic pain-like features in 19 rheumatoid arthritis patients and 21 spondyloarthritis patients, showing no statistically significant difference between the two cohorts.

Univariable analyses revealed distinct associations across the two conditions. In rheumatoid arthritis, the Health Assessment Questionnaire and current pain visual analogue scale scores associated significantly with DN4 positivity. In spondyloarthritis, the Bath Ankylosing Spondylitis Functional Index, the Ankylosing Spondylitis Disease Activity Score using C-reactive protein, and pain visual analogue scale scores showed significant associations. However, multivariable models demonstrated that only current pain intensity retained a significant association with DN4 positivity in both groups, yielding an adjusted odds ratio of 2.77 for rheumatoid arthritis and 1.90 for spondyloarthritis.

A separate monocenter prospective cohort study examining 472 chronic arthritis patients at a secondary and tertiary academic referral hospital explored a similar clinical overlap, as reported in the source. That research evaluated psoriatic arthritis, rheumatoid arthritis, and spondyloarthritis using the painDETECT questionnaire and the Widespread Pain Index. Researchers in that cohort found neuropathic-like pain frequencies of 12.9% in psoriatic arthritis, 13% in rheumatoid arthritis, and 16.4% in spondyloarthritis. Meanwhile, nociplastic pain identified via the Widespread Pain Index reached 15.7% in spondyloarthritis, significantly higher than the 7.5% observed in both rheumatoid arthritis and psoriatic arthritis groups.

Both investigations show that standard inflammatory markers fail to capture the full spectrum of patient discomfort. While targeted therapies successfully control joint inflammation, clinicians frequently encounter residual pain driven by overlapping neuropathic and nociplastic features. These findings support a comprehensive clinical evaluation of persistent pain that extends beyond routine disease activity scores to guide individualized patient management.

Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.