The Association Between Neuropathic Pain, Pain Intensity, and Inflammatory Activity in Rheumatoid Arthritis

Background: Neuropathic pain is increasingly recognized as a significant con-tributor to chronic pain and reduced quality of life in patients with rheumatoid arthritis (RA). However, its clinical correlates and relationship with disease ac-tivity and patient-reported outcomes in RA remain incompletely understood. Objective: To evaluate the prevalence of likely neuropathic pain features in RA patients and to investigate their associations with disease activity, pain intensity, fatigue, sleep quality, and health-related quality of life. Methods: In this cross-sectional study, 160 RA patients were enrolled. Neuro-pathic pain features were assessed using the PainDETECT questionnaire. Dis-ease activity was evaluated with the Disease Activity Score in 28 joints (DAS28). Pain intensity, fatigue, sleep quality, and health-related quality of life were as-sessed using the visual analog scale (VAS), Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F), Pittsburgh Sleep Quality Index (PSQI), and Short Form-36 (SF-36), respectively. Group comparisons, correlation analyses, and multivariate linear regression models were performed to identify factors associated with neuropathic pain. Results: Likely neuropathic pain was identified in 22.5% of patients. Patients with neuropathic pain had significantly higher pain intensity, greater fatigue, poorer sleep quality, and lower SF-36 scores across all domains compared with patients without neuropathic pain (all p < 0.001). Although DAS28 scores were higher in patients with neuropathic pain, PainDETECT scores correlated more strongly with VAS pain in-tensity (ρ = 0.679, p < 0.001) than with DAS28 (ρ = 0.536, p < 0.001). PainDETECT scores were negative-ly correlated with FACIT-F (ρ = −0.512, p < 0.001) and multiple SF-36 domains, indicating substantial quality-of-life impairment. In multivariate regression analysis, only pain intensity independently predicted neuropathic pain features. Conclusions: Neuropathic pain is common in RA and is more closely associated with pain intensity and patient-reported outcomes than with inflammatory activ-ity alone. Routine assessment of neuropathic pain features may facilitate more personalized and effective pain management strategies in RA, highlighting the clinical relevance of targeting neuropathic mechanisms alongside inflammation.