{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:40:55Z","timestamp":1790718055572,"version":"4.1.0"},"reference-count":40,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Nociplastic-like pain features are increasingly recognized as significant contributors to chronic pain and reduced quality of life in patients with rheumatoid arthritis (RA). However, their clinical correlates and relationship with disease activity remain incompletely understood. Objective: To evaluate the prevalence of nociplastic-like pain features in patients with RA and to investigate their associations with disease activity, pain intensity, fatigue, sleep quality, and health-related quality of life. Methods: In this cross-sectional study, 160 patients with RA were enrolled. Nociplastic-like pain features were assessed using the PainDETECT questionnaire. Disease activity was evaluated using the Disease Activity Score in 28 joints (DAS28). Pain intensity, fatigue, sleep quality, and health-related quality of life were assessed using the visual analog scale (VAS), Functional Assessment of Chronic Illness Therapy\u2013Fatigue (FACIT-F), Pittsburgh Sleep Quality Index (PSQI), and Short Form-36 (SF-36), respectively. Continuous variables were compared using t-tests or Mann\u2013Whitney U tests according to data distribution. Stepwise multivariate linear regression analysis was performed to identify independent factors associated with PainDETECT scores. Results: Pain patterns suggestive of nociplastic-like features were identified in 22.5% of patients. These patients had significantly higher pain intensity, greater fatigue (lower FACIT-F scores), poorer sleep quality (higher PSQI scores), and lower SF-36 scores across all domains compared with patients without these features (all p &lt; 0.001). PainDETECT scores showed a strong positive correlation with VAS pain intensity (r = 0.679, p &lt; 0.001) and a moderate correlation with DAS28 (r = 0.536, p &lt; 0.001). PainDETECT scores were negatively correlated with FACIT-F (r = \u22120.512, p &lt; 0.001) and several SF-36 domains. In stepwise multivariate regression analysis, pain intensity, tender joint count, and education level emerged as independent predictors of nociplastic-like pain features, whereas inflammatory markers (CRP, ESR) and DAS28 were excluded from the model. Conclusions: Nociplastic-like pain features are common in RA and are independently associated with pain intensity, joint tenderness, and psychosocial factors rather than inflammatory activity alone. Routine assessment of these features is essential for personalized pain management and underscores the importance of considering potential central sensitization mechanisms in addition to traditional anti-inflammatory therapies.<\/jats:p>","DOI":"10.3390\/jcm15041601","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T08:51:09Z","timestamp":1771491069000},"page":"1601","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Association Between Neuropathic Pain, Pain Intensity, and Inflammatory Activity in Rheumatoid Arthritis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2684-165X","authenticated-orcid":false,"given":"Zeynel Abidin","family":"Akar","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Dicle University, 21300 Diyarbak\u0131r, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilan","family":"Y\u0131ld\u0131r\u0131m","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Dicle University, 21300 Diyarbak\u0131r, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8196-7470","authenticated-orcid":false,"given":"\u00d6mer","family":"Karakoyun","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Faculty of Medicine, Dicle University, 21280 Diyarbak\u0131r, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1290-4491","authenticated-orcid":false,"given":"Kadir","family":"Kaya","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Faculty of Medicine, \u0130stinye University, 34010 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet","family":"\u00c7a\u011flayan","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Dicle University, 21300 Diyarbak\u0131r, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pelin","family":"Oktayo\u011flu","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Dicle University, 21300 Diyarbak\u0131r, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remzi","family":"\u00c7evik","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Dicle University, 21300 Diyarbak\u0131r, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s11914-018-0473-5","article-title":"Mechanisms for Joint Pain in Rheumatoid Arthritis (RA): From Cytokines to Central Sensitization","volume":"16","author":"Zhang","year":"2018","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1007\/s10067-025-07331-0","article-title":"Residual pain and fatigue are affected by disease perception in rheumatoid arthritis in sustained clinical and ultrasound remission","volume":"44","author":"Perniola","year":"2025","journal-title":"Clin. Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s11916-012-0303-x","article-title":"Pain in rheumatoid arthritis","volume":"16","author":"Walsh","year":"2012","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2360","DOI":"10.1093\/rheumatology\/keac671","article-title":"Non-inflammatory pain in inflammatory arthritis","volume":"62","author":"Das","year":"2023","journal-title":"Rheumatology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/BOR.0000000000000929","article-title":"Fibromyalgia and centralized pain in the rheumatoid arthritis patient","volume":"35","author":"Minhas","year":"2023","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"R83","DOI":"10.1186\/ar3353","article-title":"Pain persists in DAS28 rheumatoid arthritis remission but not in ACR\/EULAR remission: A longitudinal observational study","volume":"13","author":"Lee","year":"2011","journal-title":"Arthritis Res. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"105399","DOI":"10.1016\/j.jbspin.2022.105399","article-title":"Assessing central sensitization with quantitative sensory testing in inflammatory rheumatic diseases: A systematic review","volume":"89","author":"Trouvin","year":"2022","journal-title":"Jt. Bone Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1186\/s13075-015-0761-8","article-title":"Nociplastic-like pain and cross-sectional associations in rheumatoid arthritis","volume":"17","author":"Koop","year":"2015","journal-title":"Arthritis Res. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/acr.25694","article-title":"Beyond Inflammation: Why Understanding the Brain Matters in Inflammatory Arthritis","volume":"78","author":"Kelleher","year":"2025","journal-title":"Arthritis Care Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1186\/s13075-024-03407-5","article-title":"Contribution of inflammation markers and quantitative sensory testing (QST) indices of central sensitisation to rheumatoid arthritis pain","volume":"26","author":"Georgopoulos","year":"2024","journal-title":"Arthritis Res. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Belan\u010di\u0107, A., Sener, S., Sener, Y.Z., Fajki\u0107, A., Vu\u010dkovi\u0107, M., Markoti\u0107, A., Beni\u0107, M.S., Poto\u010dnjak, I., Pavlovi\u0107, M.R., and Radi\u0107, J. (2025). Effects of Janus Kinase Inhibitors on Rheumatoid Arthritis Pain: Clinical Evidence and Mechanistic Pathways. Biomedicines, 13.","DOI":"10.3390\/biomedicines13102429"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Taylor, P.C., Lee, Y.C., Fleischmann, R., Takeuchi, T., Perkins, E.L., Fautrel, B., Zhu, B., Quebe, A.K., Gaich, C.L., and Zhang, X. (2019). Achieving Pain Control in Rheumatoid Arthritis with Baricitinib or Adalimumab Plus Methotrexate: Results from the RA-BEAM Trial. J. Clin. Med., 8.","DOI":"10.3390\/jcm8060831"},{"key":"ref_13","first-page":"94","article-title":"Pain mechanisms in rheumatoid arthritis","volume":"35","author":"McWilliams","year":"2017","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"491","DOI":"10.2147\/PRBM.S352984","article-title":"Quality of Life and Depression in Rheumatoid Arthritis Patients Treated with Biologics\u2014A Single Centre Experience","volume":"15","author":"Szalonka","year":"2022","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1002\/ejp.1651","article-title":"The burden of pain in rheumatoid arthritis: Impact of disease activity and psychological factors","volume":"24","author":"Pouplin","year":"2020","journal-title":"Eur. J. Pain"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1177\/1759720X11408999","article-title":"Management of chronic pain in the rheumatic diseases with insights for the clinician","volume":"3","author":"Fitzcharles","year":"2011","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"31","DOI":"10.2147\/OARRR.S291388","article-title":"Pain: A Review of Interleukin-6 and Its Roles in the Pain of Rheumatoid Arthritis","volume":"13","author":"Sebba","year":"2021","journal-title":"Open Access Rheumatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1136\/ard-2023-225414","article-title":"Predictors for severe persisting pain in rheumatoid arthritis are associated with pain origin and appraisal of pain","volume":"83","author":"Baerwald","year":"2024","journal-title":"Ann. Rheum. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1002\/acr.22301","article-title":"Criteria for the diagnosis of fibromyalgia: Validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria","volume":"66","author":"Bennett","year":"2014","journal-title":"Arthritis Care Res"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1111\/pme.12222","article-title":"Turkish version of the painDETECT questionnaire in the assessment of neuropathic pain: A validity and reliability study","volume":"14","author":"Alkan","year":"2013","journal-title":"Pain Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Nijs, J., Lahousse, A., Kapreli, E., Bilika, P., Sara\u00e7o\u011flu, \u0130., Malfliet, A., Coppieters, I., De Baets, L., Leysen, L., and Roose, E. (2021). Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future. J. Clin. Med., 10.","DOI":"10.3390\/jcm10153203"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/1477-7525-1-79","article-title":"The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: Properties, applications, and interpretation","volume":"1","author":"Webster","year":"2003","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_23","first-page":"553","article-title":"Evaluation of sleep disorders in cancer patients based on Pittsburgh Sleep Quality Index","volume":"24","author":"Akman","year":"2015","journal-title":"Eur. J. Cancer Care"},{"key":"ref_24","first-page":"558","article-title":"Short Form Health Survey version-2.0 Turkish (SF-36v2) is an efficient outcome parameter in musculoskeletal research","volume":"50","year":"2016","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_25","first-page":"579","article-title":"Use of the painDETECT tool in rheumatoid arthritis suggests neuropathic and sensitization components in pain reporting","volume":"7","author":"Ahmed","year":"2014","journal-title":"J. Pain Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"140","DOI":"10.14744\/nci.2023.81231","article-title":"Impact of central sensitization on clinical parameters in patients with rheumatoid arthritis","volume":"11","author":"Mesci","year":"2024","journal-title":"North. Clin. Istanb."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"R160","DOI":"10.1186\/ar2842","article-title":"The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: A cross-sectional study","volume":"11","author":"Lee","year":"2009","journal-title":"Arthritis Res. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"152207","DOI":"10.1016\/j.semarthrit.2023.152207","article-title":"A systematic review and meta-analysis of questionnaires to screen for pain sensitisation and neuropathic like pain in inflammatory arthritis","volume":"61","author":"Arumalla","year":"2023","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"418","DOI":"10.2174\/0115733971309885241011105213","article-title":"Prevalence and Associated Factors of Central Sensitization in Patients with Chronic Inflammatory Rheumatic Disease","volume":"21","author":"Berrichi","year":"2025","journal-title":"Curr. Rheumatol. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.3899\/jrheum.111393","article-title":"Sex differences in pain scores and localization in inflammatory arthritis: A systematic review and metaanalysis","volume":"39","author":"Barnabe","year":"2012","journal-title":"J. Rheumatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2472","DOI":"10.1002\/acr.25178","article-title":"Sex Differences in Pain and Quantitative Sensory Testing in Patients With Rheumatoid Arthritis","volume":"75","author":"Vogel","year":"2023","journal-title":"Arthritis Care Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"103423","DOI":"10.1016\/j.autrev.2023.103423","article-title":"Residual pain in rheumatoid arthritis: Is it a real problem?","volume":"22","author":"Zen","year":"2023","journal-title":"Autoimmun. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Rifbjerg-Madsen, S., Christensen, A.W., Christensen, R., Hetland, M.L., Bliddal, H., Kristensen, L.E., Danneskiold-Sams\u00f8e, B., and Amris, K. (2017). Pain and pain mechanisms in patients with inflammatory arthritis: A Danish nationwide cross-sectional DANBIO registry survey. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0180014"},{"key":"ref_34","first-page":"980","article-title":"Central sensitisation features are associated with neuropathic pain-like symptoms in patients with longstanding rheumatoid arthritis: A cross-sectional study using the central sensitisation inventory","volume":"40","author":"Saitou","year":"2022","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2076328","DOI":"10.1155\/2020\/2076328","article-title":"Pain Mechanism in Rheumatoid Arthritis: From Cytokines to Central Sensitization","volume":"2020","author":"Cao","year":"2020","journal-title":"Mediat. Inflamm."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Paroli, M., and Sirinian, M.I. (2025). Pathogenic Crosstalk Between the Peripheral and Central Nervous System in Rheumatic Diseases: Emerging Evidence and Clinical Implications. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26136036"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1093\/ptj\/pzy030","article-title":"A Mechanism-Based Approach to Physical Therapist Management of Pain","volume":"98","author":"Chimenti","year":"2018","journal-title":"Phys. Ther."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"jrm40188","DOI":"10.2340\/jrm.v56.40188","article-title":"Rehabilitation interventions for neuropathic pain: A systematic review and meta-analysis of randomized controlled trials","volume":"56","author":"Ghafouri","year":"2024","journal-title":"J. Rehabil. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1016\/j.jpain.2013.08.007","article-title":"The association of sleep and pain: An update and a path forward","volume":"14","author":"Finan","year":"2013","journal-title":"J. Pain"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1038\/s41386-019-0439-z","article-title":"Sleep deficiency and chronic pain: Potential underlying mechanisms and clinical implications","volume":"45","author":"Haack","year":"2020","journal-title":"Neuropsychopharmacology"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1601\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T09:06:43Z","timestamp":1771492003000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1601"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,19]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15041601"],"URL":"https:\/\/doi.org\/10.3390\/jcm15041601","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,19]]}}}