What Causes Rheumatoid Arthritis Pain?

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Why ask what causes rheumatoid arthritis pain?

Today we answer a letter from a reader that raises key questions about living with rheumatoid disease (RD). Why is it so painful? Why doesn’t treatment take away pain? Why isn’t the pain dealt with? In part, the answer is found in another question: What causes rheumatoid arthritis pain?

Until recently, no one had any idea. So there have been many crazy stupid evil theories about how people with rheumatoid disease are depressed or have a newly minted maladaptive pain processing disorder.

Letter from a reader:

I just want to thank you for your help. It has been hard to deal with my RA since 2012. I am not that old only 64 but feel like 90, so what will tomorrow be like? I would like to address the pain issue, since I am not getting much help with it. I would really like to hear what you have to say about it.

Sincerely yours, Pauline

What Causes Rheumatoid Arthritis Pain

Where we stand on what causes rheumatoid arthritis pain

If someone responds very well to treatment, disease activity and pain are reduced. Unfortunately that is still a minority of people with rheumatoid disease (PRD). So, many posts on RA Warrior deal specifically with the topic of RD / RA pain: 42 with a Tag rheumatoid arthritis pain and 21 with a Tag pain tolerance / RA stoicism.

Let’s take a moment to see where we are on the topic of what causes rheumatoid arthritis pain:

1) As I wrote last year on the role of pain in RD / RA, Pain is the body’s primary indicator of a problem. Pain has always been an obvious symptom of rheumatoid disease activity.

2) Part 2 of that series discussed the popular idea of so-called remaining pain in RA, pain that is leftover after disease treatments are given, regardless of other remaining symptoms.

3) Part 3 dug deep into the data to show that remaining pain is actually a useless model since RA pain persists as long as the disease is active.

But why, Kelly? Why does RD / RA cause pain? And why isn’t there enough help for RA pain?

Science is finally bringing some answers. They are answers that vindicate PRD by exploring what really causes rheumatoid arthritis pain.I’m only 64 but feel like 90, what will tomorrow be? …address pain since I’m not getting much help Click To Tweet

A protein causes rheumatoid arthritis pain?

Experiments in molecular pain research at the Karolinska Institute in Sweden have shown that autoantibodies against citrullinated proteins (ACPA) can produce pain without any signs of inflammation or swelling.1

(Don’t let the long words trouble you: ACPA are what is tested in an anti-CCP test, the most specific test for RD.)

According to the investigators, some types of ACPA could cause long-lasting pain even in the absence of classic inflammation symptoms. Other laboratory research by the same Institute also demonstrated ACPA’s role in joint destruction.2

Read this slowly a couple of times for it to sink in: Laboratory research is separating pain from inflammation,1 destruction from inflammation,2 and “clinical disease activity” (swelling) from structural damage.3 This represents a change in the template for this disease.

For years I have advocated such change based on facts that patients report. Why do a majority of PRD report times of “invisible illness” when they suffer pain, stiffness, weakness, or disability without obvious external swelling? The reason is that many assumptions about RD are wrong. They were not based in either research with patients or the laboratory.

For example, what causes stiffness? They claim it’s just swelling. But what about stiffness that occurs without swelling?
New Design on Mugs & T-shirts etc. Click to see more. I am not my Rheumatoid Disease

What if we find biological causes for rheumatoid arthritis pain?

What if biochemistry and biophysics are able to demonstrate what causes rheumatoid arthritis pain and it has nothing to do with laziness or weakness or secondary gains?

What if PRD did not have to deal with assumptions that their illness was due to character flaws? Then we could find the true causes of disease activity, including pain. And we would do whatever is necessary to humanely treat Pauline’s (and our) pain in the meantime.

If ACPA causes rheumatoid arthritis pain, then we’re not crazy. The molecular pain researchers didn’t put it like that. But I’ve read that paper at least ten times in the past year and that’s what I heard.

If molecular pain research shows ACPA /anti-CCP causes RD /RA pain, then we’re not crazy. #rheum Click To Tweet

Read this excerpt from their conclusion and let me know what you think.

“This insight should dramatically alter our approach to diagnosing as well as treating ACPA+ arthralgia, and may indicate new potential targets for the prevention of development of clinical signs of RA in this early phase of disease development… Our findings may also provide a possible explanation to the remaining pain in some patients with ACPA+ RA who have been successfully treated for their inflammation; levels of ACPA do normally persist also after successful treatment of inflammation.”

WHAT DO YOU THINK ABOUT THE NEW RESEARCH SHOWING ANTIBODIES ACT DIRECTLY TO CAUSE PAIN?

WHAT IS YOUR EXPERIENCE WITH PAIN AND NO OBVIOUS SWELLING IN YOURSELF, LOVED ONES, OR PATIENTS?

HAVE YOU HAD YOUR ANTI-CCP / ACPA TESTED?

In honor of new proof we are not crazy, I created a new design in our RA Warrior store. Click here to see a few items with the new I am not my Rheumatoid Disease design.

Recommended reading

FOOTNOTES

1 Wigerblad G, et al. Autoantibodies to citrullinated proteins induce joint pain independent of inflammation via a chemokine-dependent mechanism. Ann Rheum Dis. 27 Nov 2016;[cited 2017 Mar 24]75:730–738. DOI: 10.1136/annrheumdis-2015-208094

2 Krishnamurthy A, Vijay J, Hensvold H, et al. Identification of a novel chemokine-dependent molecular mechanism underlying rheumatoid arthritis-associated autoantibody-mediated bone destruction. Ann Rheum Dis 2016;[cited 2017 Mar 26]75:721–9. DOI 10.1136/annrheumdis2015208093

3 Villeneuve E, Haraoui B. Uncoupling of disease activity and structural damage. Does it matter clinically? Ann Rheum Dis 2013;[cited 2017 Mar 26]72:12. DOI:10.1136/annrheumdis2012202650

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Kelly Young. All rights reserved.

This entry was posted on Monday, March 27th, 2017 at 12:52 am and is filed under Don't miss this!. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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