PAIN IN RHEUMATOID ARTHRITIS: SPECIFIC FEATURES OF ITS DEVELOPMENT AND METHODS OF CORRECTION
The pain syndrome holds a central position in the clinical picture of rheumatoid arthritis (RA). Articular inflammation is an essential, but not the only, factor that determines the occurrence of pain. Extraarticular soft tissue pathology can play an important role in the formation of pain perceptions in RA. The pain that increases on movement with involvement of affected structures, as well as local tenderness on palpation and dysfunction of an altered segment are the major clinical manifestations of extraarticular soft tissue involvement in RA. Swelling in the area of appropriate tendons and synovial bursae can be seen when superficially located anatomic formations are involved. Magnetic resonance imaging and ultrasonography permit more accurate determination of the site and pattern of an involvement. The pain and functional impairments associated with extraarticular soft tissue pathology determine a need for additional therapy that can correct the existing disorders and improve the quality of life in patients. The major components of this treatment are sparing routine and systemic and local drug therapy. Diclofenac sodium is one of the most universal agents that allow simultaneous monitoring of various pathogenetic mechanisms of the disease. Local glucocorticoids may be used if the sparing routine and nonsteroidal anti-inflammatory drugs fail to control the pain syndrome effectively.