{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:02:20Z","timestamp":1790258540719,"version":"4.1.0"},"reference-count":125,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Mol. Sci.","IJMS"],"abstract":"<jats:p>Arthroplasty can provide substantial pain and functional improvement in inflammatory arthritis, but structural indications alone do not determine how much of a patient\u2019s overall symptom burden will respond to surgery. Persistent or widespread pain may reflect active inflammation, irreversible joint damage, neuropathic or extra-articular generators, and distributed pain amplification, which we use as a descriptive term for pain extending beyond the target joint and influenced by broader sensory, symptomatic, and contextual processes. This critical structured narrative review integrates direct inflammatory-arthritis arthroplasty evidence, disease-specific pain-phenotyping studies, indirect osteoarthritis perioperative data, and molecular and mechanistic literature. We link cytokine\/prostaglandin signalling, neurotrophin- and ion-channel-mediated nociceptor sensitisation, immunosensory signalling, and spinal neuron\u2013glia plasticity to peripheral and central nociceptive amplification. We then propose the Target-Joint Attribution and Pain-Amplification Framework, comprising four provisional clinical phenotypes (A\u2013D): structural-concordant, inflammation-dominant, mixed target-joint\/distributed pain-amplification, and distributed pain-dominant. Questionnaire or sensory-test thresholds do not establish mechanisms or surgical eligibility. The framework translates these molecular and neuroimmune mechanisms into testable hypotheses for perioperative phenotyping, biomarker validation, and interpretation of postoperative pain trajectories. Direct phenotype-specific evidence in inflammatory-arthritis arthroplasty remains sparse; prospective validation integrating joint-specific outcomes with molecular and sensory measures is required.<\/jats:p>","DOI":"10.3390\/ijms27198551","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:26:11Z","timestamp":1790256371000},"page":"8551","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Synovitis: Molecular and Neuroimmune Mechanisms Informing Target-Joint Attribution and Pain Phenotyping for Arthroplasty in Inflammatory Arthritis"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2140-9732","authenticated-orcid":false,"given":"Michal","family":"Pruc","sequence":"first","affiliation":[{"name":"Institute of Medical Science, The John Paul II Catholic University of Lublin, 20-708 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1885-7654","authenticated-orcid":false,"given":"Andrzej","family":"Bielski","sequence":"additional","affiliation":[{"name":"Clinical Department of Rheumatology, Provincial Integrated Hospital in Plock, 09-400 Plock, Poland"},{"name":"Collegium Medicum, The Mazovian Academy in Plock, 09-402 Plock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Weglowski","sequence":"additional","affiliation":[{"name":"Institute of Medical Science, The John Paul II Catholic University of Lublin, 20-708 Lublin, Poland"},{"name":"Clinical Department of Trauma and Orthopedic Surgery, The John Paul II Catholic University of Lublin, 21-300 Radzyn Podlaski, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaroslaw","family":"Pecold","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopedic Surgery, Ruda Slaska City Hospital, 41-793 Ruda Slaska, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0973-5455","authenticated-orcid":false,"given":"Lukasz","family":"Szarpak","sequence":"additional","affiliation":[{"name":"Institute of Medical Science, The John Paul II Catholic University of Lublin, 20-708 Lublin, Poland"},{"name":"Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1212-7256","authenticated-orcid":false,"given":"Iwona","family":"Jannasz","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Olczak-Pruc","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, ViaMed Ursus Medical Center, 02-495 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Lewicki","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Silesian Center for Rheumatology, 43-450 Ustron, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0516-3231","authenticated-orcid":false,"given":"Maciej","family":"Maslyk","sequence":"additional","affiliation":[{"name":"Institute of Biological Science, The John Paul II Catholic University of Lublin, 20-950 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahdi","family":"Al-Jeabory","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopedic Surgery, Silesian Center for Rheumatology, 43-450 Ustron, Poland"},{"name":"Clinical Department of Orthopedics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.3899\/jrheum.140011","article-title":"Patients with rheumatoid arthritis are more likely to have pain and poor function after total hip replacements than patients with osteoarthritis","volume":"41","author":"Goodman","year":"2014","journal-title":"J. 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