Chronic pain in rheumatoid arthritis: clinical and psychological implications

Abstract

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by persistent pain that affects functionality and mental well-being, even in remission, negatively impacting quality of life. Methods: A quantitative, analytical, cross-sectional, and retrospective systematic review was conducted. Articles published between 2020 and 2025 in databases such as PubMed, Scopus, and Cochrane were collected, which explored the relationship between chronic pain, mental health, and quality of life in adults with RA. Strict inclusion and exclusion criteria were applied, along with methodological quality assessment tools. Results: Studies revealed a prevalence of persistent pain of up to 80% in RA patients, associated with anxiety, depression, stress, fatigue, and low self-efficacy, leading to higher opioid use in patients with a history of mental health problems, worse functional prognosis in older adults, and the significant influence of fibromyalgia and nociplastic pain, although non-pharmacological interventions such as yoga, mHealth, and cognitive-behavioral therapy showed benefits in emotional well-being. Conclusions: RA considerably impacts mental health, increasing the prevalence of anxiety, depression, and stress, with clinical implications such as worse pain perception and higher risk of chronic opioid use, calling for the integration of mental health assessment into routine management. Psychologically, chronic pain in RA is not only due to inflammation but also to factors such as psychosocial stress and loneliness, highlighting the need for psychosocial interventions and a multidisciplinary approach that considers mental health as an integral component of treatment.