Effect of biological DMARDs and JAK inhibitors in pain of chronic inflammatory arthritis

ABSTRACT

Introduction

The advent of biological disease‐modifying anti‐rheumatic drugs (bDMARDs) and, more recently, of Janus kinase inhibitors (JAKi) has had a major impact on the long-term outcomes of chronic inflammatory arthritis (IA). However, the persistence of pain, even in patients with a complete pharmacological control of peripheral inflammation, represents an important clinical challenge in the treatment of IA.

Areas covered

In this review, we provide an overview of possible mechanisms underlying pain in IA and its assessment, as well as the effects of bDMARDs and JAKi on pain management.

Expert opinion

The overall data showed a good effect of bDMARDs and JAKi on pain, which is more pronounced for JAKi. However, it is challenging to distinguish the effect on the different types of pain (nociceptive, neuropathic, and nociplastic).

KEYWORDS:

• pain
• rheumatoid arthritis
• psoriatic arthritis
• DMARDs
• JAKIs
• MCID

Article highlights

• Pain in chronic inflammatory arthritis is a complex phenomenon derived from the interplay of multiple pain mechanisms

• Biological disease‐modifying anti‐rheumatic drugs and Janus kinase inhibitors have a good efficacy and safety profile for treating patients with rheumatic inflammatory disease

• These drugs are associated with the improvement of pain

• However, a group of patients with persistent pain remains and should be the object of future research

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

A Alciati, F Atzeni, M Di Carlo, C Siragusano, A Palumbo, IF Masala participated in the literature search and the summary of all articles. All of the authors drafted the manuscript, which was critically reviewed by F Atzeni and A Alciati. All of the authors read and approved the final manuscript.