Abstract：
BACKGROUND: Chronic pain is a common symptom of rheumatic diseases that impacts patients\' quality of life. While non-pharmacological approaches are often recommended as first-line treatments, pharmacological interventions are important for pain management. However, the effectiveness and safety of different pharmacological treatments for chronic pain in rheumatic diseases are unclear.
METHODS: This review critically synthesizes the current evidence base to guide clinicians in selecting appropriate pharmacological treatments for their patients, considering the expected benefits and potential risks and side effects.
RESULTS: For osteoarthritis, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, opioids, and antidepressants are commonly used, with NSAIDs being the most recommended. In addition, topical agents, such as topical NSAIDs, are recommended for localized pain relief. For fibromyalgia, amitriptyline, serotonin and noradrenaline reuptake inhibitors (SNRIs), and gabapentinoids are commonly used, with SNRIs being the most recommended. For back pain, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, opioids are used only for acute of flare-up pain, whereas neuropathic pain drugs are only used for chronic radicular pain. For inflammatory rheumatic diseases, disease-modifying antirheumatic drugs (DMARDs) and biological agents are recommended to slow disease progression and manage symptoms.
CONCLUSIONS: While DMARDs and biological agents are recommended for inflammatory rheumatic diseases, pharmacological treatments for other rheumatic diseases only alleviate symptoms and do not provide a cure for the underlying condition. The use of pharmacological treatments should be based on the expected benefits and evaluation of side effects, with non-pharmacological modalities also being considered, especially for fibromyalgia.
METHODS: This review critically synthesizes the current evidence base to guide clinicians in selecting appropriate pharmacological treatments for their patients, considering the expected benefits and potential risks and side effects.
RESULTS: For osteoarthritis, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, opioids, and antidepressants are commonly used, with NSAIDs being the most recommended. In addition, topical agents, such as topical NSAIDs, are recommended for localized pain relief. For fibromyalgia, amitriptyline, serotonin and noradrenaline reuptake inhibitors (SNRIs), and gabapentinoids are commonly used, with SNRIs being the most recommended. For back pain, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, opioids are used only for acute of flare-up pain, whereas neuropathic pain drugs are only used for chronic radicular pain. For inflammatory rheumatic diseases, disease-modifying antirheumatic drugs (DMARDs) and biological agents are recommended to slow disease progression and manage symptoms.
CONCLUSIONS: While DMARDs and biological agents are recommended for inflammatory rheumatic diseases, pharmacological treatments for other rheumatic diseases only alleviate symptoms and do not provide a cure for the underlying condition. The use of pharmacological treatments should be based on the expected benefits and evaluation of side effects, with non-pharmacological modalities also being considered, especially for fibromyalgia.
摘要：
背景：慢性疼痛是风湿性疾病的常见症状，影响患者的生活质量。虽然非药物方法通常被推荐作为一线治疗，药物干预对疼痛管理很重要.然而,不同药物治疗风湿性疾病慢性疼痛的有效性和安全性尚不清楚.
方法：这篇综述严格地综合了当前的证据基础，以指导临床医生为患者选择合适的药物治疗方法，考虑预期收益、潜在风险和副作用。
结果：对于骨关节炎，非甾体抗炎药（NSAIDs），对乙酰氨基酚,阿片类药物,通常使用抗抑郁药，NSAIDs是最推荐的。此外,局部用药,如局部NSAIDs，建议局部疼痛缓解。对于纤维肌痛，阿米替林,5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRIs），加巴喷丁是常用的，SNRIs是最推荐的。背部疼痛，非甾体抗炎药（NSAIDs），对乙酰氨基酚,阿片类药物仅用于急性发作性疼痛，而神经性疼痛药物仅用于慢性神经根性疼痛。对于炎症性风湿性疾病，建议使用改善病情的抗风湿药(DMARDs)和生物制剂来减缓疾病进展和控制症状.
结论：虽然DMARDs和生物制剂被推荐用于炎症性风湿性疾病，其他风湿性疾病的药物治疗只能缓解症状，不能治愈潜在的疾病。药物治疗的使用应基于预期的益处和副作用的评估，还考虑了非药理学模式，尤其是纤维肌痛.
方法：这篇综述严格地综合了当前的证据基础，以指导临床医生为患者选择合适的药物治疗方法，考虑预期收益、潜在风险和副作用。
结果：对于骨关节炎，非甾体抗炎药（NSAIDs），对乙酰氨基酚,阿片类药物,通常使用抗抑郁药，NSAIDs是最推荐的。此外,局部用药,如局部NSAIDs，建议局部疼痛缓解。对于纤维肌痛，阿米替林,5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRIs），加巴喷丁是常用的，SNRIs是最推荐的。背部疼痛，非甾体抗炎药（NSAIDs），对乙酰氨基酚,阿片类药物仅用于急性发作性疼痛，而神经性疼痛药物仅用于慢性神经根性疼痛。对于炎症性风湿性疾病，建议使用改善病情的抗风湿药(DMARDs)和生物制剂来减缓疾病进展和控制症状.
结论：虽然DMARDs和生物制剂被推荐用于炎症性风湿性疾病，其他风湿性疾病的药物治疗只能缓解症状，不能治愈潜在的疾病。药物治疗的使用应基于预期的益处和副作用的评估，还考虑了非药理学模式，尤其是纤维肌痛.
