Systematic review and meta-analysis of analgesic treatment options in patients with rheumatoid arthritis related pain

Abstract Background Rheumatoid arthritis is a chronic autoimmune disorder characterized by joint destruction and inflammation. Persistent pain is a common symptom, often impacting quality of life, physical function, and mental health. Despite its prevalence, limited guidance exists for managing chronic rheumatoid arthritis-related pain. This systematic review and meta-analysis aimed to evaluate the effectiveness of various analgesic therapies for managing rheumatoid arthritis-related pain symptoms. Methods A comprehensive search of PubMed, EMBASE, Cochrane, and ClinicalTrials.gov was conducted from database inception through November 7, 2024. Eligible studies included randomized controlled trials and prospective cohorts reporting pain outcomes in adult rheumatoid arthritis patients. Pain score data was stratified by scale (5-point, 10-point, 100-point) and analyzed using a random-effects model. Results Twenty-six studies covering 52 treatment regimens were included. Etodolac demonstrated significant pain reduction on a 5-point scale (200 mg: 3.24; 95% CI: 2.86 to 3.63; p < 0.001; 300 mg: 3.35; 95% CI: 2.96 to 3.74; p = 0.00). Piroxicam also showed benefit (20 mg: 3.35; 95% CI: 2.91 to 3.78; p < 0.001). On the 10-point scale, only extracorporeal shock wave therapy significantly reduced pain (3.36; 95% CI: 2.25 to 4.48; p < 0.001). Celecoxib (Celbesta) (200 mg BID) was most effective in the 100-point subgroup (1.73; 95% CI: 1.32 to 2.15; p < 0.001). Heterogeneity was high (I² = 91.1%, 94.1%, 60.2%; all p < 0.05), and publication bias was present. Conclusion Several therapies demonstrated substantial pain relief, but heterogeneity, publication bias, and varying study quality limit generalizability. High-quality, long-term trials with standardized pain assessments are needed to guide personalized rheumatoid arthritis pain management. Clinical trial number PROSPERO CRD42024593971, 4 October 2024.