Table 1 Key systematic reviews reporting the efficacy of drugs for pain in patients with RA
From: Pharmacological pain management in patients with rheumatoid arthritis: a narrative literature review
Medicine class | Specific medicine | Systematic review | Year | Number of trials | Publication year range | Risk of bias | Duration of trials | Total number of patients | Key findings |
|---|---|---|---|---|---|---|---|---|---|
Analgesics | Paracetamol | Hazlewood et al. [31] | 2012 | 12 (9) | 1959–1993 | High | < 1 to 14 days | 493 (412) | • Small benefits of paracetamol over placebo on “pain relief” |
Opioids | Whittle et al. [32] | 2011 | 11 (3) | 1969–2006 | High | < 1 day to 6 weeks | 672 (324) | • 18 more people (out of 100) reported good/very good improvement in symptoms with opioids (vs. placebo) • 30 more people (out of 100) reported adverse events with opioids (vs. placebo) | |
NSAIDs | Paglia et al. [36] | 2021 | 21 (13) | 1986–2010 | High | 2 to 26 weeks | 10,503 (6679) | • Naproxen 1000 mg provided significant reductions in pain vs placebo • No significant benefit observed for other NSAIDs | |
Neuromodulators | Gabapentinoids | NICE Guideline [16] | 2008 | 0 | - | - | - | - | • No trials identified |
Tricyclic anti-depressants | Richards et al. [39] | 2011 | 8 | 1977–2000 | High | < 1 day to 12 weeks | 652 | • Conflicting evidence of a benefit | |
Nabiximols (cannabinoids) | Fitzcharles et al. [40] | 2016 | 1 | 2006 | High | 5 weeks | 58 | • Significant improvement in pain on movement scores seen with active vs. placebo treatment | |
Nefopam and Capsaicin | Richards et al. [38] | 2012 | 3 | 1986–1991 | High | 2 to 4 weeks | 52 Nefopam 31 Capsaicin | • Significant reduction in pain with nefopam vs. placebo after 2 weeks, but more adverse events • Greater reduction in pain with topical capsaicin vs placebo at 1 and 2 weeks, but 44% had application site burning | |
Glucocorticoids | Multiple | McWilliams et al. [62] | 2021 | 33 | 1967–2017 | Variable | 1 week to 2 years | 3123 | • Significant benefit on pain intensity at 0 to 3 months |
Synthetic DMARDS | Methotrexate | Lopez-Olivo et al. [41] | 2014 | 7 (4) | 1985–1999 | Low | 3 to 12 months | 732 (468) | • Significantly lower pain scores with methotrexate at 3 to 12 months |
Sulphasalazine | Suarez-Almazor et al. [46] | 2000 | 6 (3) | 1983–1995 | Variable | 6 to 12 months | 468 (179) | • Significantly lower pain scores with sulphasalazine at 6 to 12 months | |
Leflunomide | Osiri et al. [45] | 2003 | 33 (3) | 1994–2007 | Variable | 6–24 months | 6676 (724) | • Significantly lower pain scores with leflunomide at 6 months | |
Biologic DMARDs | Multiple | Jansen et al. [53] | 2014 | 17 (13) | 1999–2011a | Variable | 24 weeksb | 6477 (4211) | • Significantly greater reductions in pain with anti-TNF and tocilizumab |
Targeted synthetic DMARDs | Multiple | Tóth et al. [61] | 2022 | 50 (21) | 2009–2020 | Mainly Lowc | < 6 months | 24,135 (9588) | • Significantly lower pain scores with JAK inhibitors vs. placebo or biologic DMARDs |