Disproportionate articular pain is a frequent phenomenon in rheumatoid arthritis and responds to treatment with sarilumab

Ernest Choy*, Vivian Bykerk, Yvonne C. Lee, Hubert Van Hoogstraten, Kerri Ford, Amy Praestgaard, Serge Perrot, Janet Pope, Anthony Sebba

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Objectives: In some patients with RA, joint pain is more severe than expected based on the amount of joint swelling [referred to as disproportionate articular pain (DP)]. We assessed DP prevalence and the effects of sarilumab, an IL-6 inhibitor, on DP. Methods: Data from RA patients treated with placebo or 200 mg sarilumab in the phase 3 randomized controlled trials (RCTs) MOBILITY and TARGET, adalimumab 40 mg or sarilumab 200 mg in the phase 3 RCT MONARCH and sarilumab 200 mg in open-label extensions (OLEs) were used. DP was defined as an excess tender 28-joint count (TJC28) over swollen 28-joint count (SJC28) of ≥7 (TJC28 - SJC28 ≥ 7). Treatment response and disease activity were determined for patients with and without DP. Results: Of 1531 sarilumab 200 mg patients from RCTs, 353 (23%) had baseline DP. On average, patients with DP had higher 28-joint DAS using CRP (DAS28-CRP) and pain scores than patients without DP, whereas CRP levels were similar. After 12 and 24 weeks, patients with baseline DP treated with sarilumab were more likely to be DP-free than those treated with placebo or adalimumab. In RCTs, more sarilumab-treated patients achieved low disease activity vs comparators, regardless of baseline DP status. In OLEs, patients were more likely to lose rather than gain DP status. Conclusion: About one-quarter of patients with RA experienced DP, which responded well to sarilumab. These data support the concept that other mechanisms (potentially mediated via IL-6) in addition to inflammation may contribute to DP in RA. Trial registrations: NCT01061736, NCT02332590, NCT01709578, NCT01146652.

Original languageEnglish (US)
Pages (from-to)2386-2393
Number of pages8
JournalRheumatology (United Kingdom)
Issue number7
StatePublished - Jul 1 2023


  • IL-6
  • RA
  • analgesia
  • pain
  • sarilumab

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Rheumatology


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