More than half of adults with autoimmune rheumatic diseases have overlapping pain
More than half of adults with autoimmune rheumatic disease had at least one overlapping pain condition, and nearly one in four had several. The pattern varied by diagnosis, age and sex.
Pain in autoimmune rheumatic disease is often more layered than inflammation alone can explain. In a large claims analysis of 149,742 patients, 57.5% had at least one chronic overlapping pain condition and 22.7% had multiple conditions, a finding that pushes rheumatology toward a multimorbidity model rather than a single-diagnosis approach.
The study used 2008-2021 Merative MarketScan Commercial Claims and Encounters data and examined adults with autoimmune rheumatic disease, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Sjögren’s disease, systemic lupus erythematosus and systemic sclerosis. Chronic low back pain was the most common overlapping pain condition at 41.4%, followed by fibromyalgia at 21.1%. Women and adults ages 31-50 had the highest prevalence of these pain syndromes.
The pattern was not random. Fibromyalgia and chronic low back pain, along with migraine and chronic low back pain, occurred together more often than expected by chance. That matters because some pain in these patients is not simply a marker of active immune disease. Central sensitization, psychosocial stressors and separate chronic pain disorders can all amplify symptoms, which means escalating immunosuppression alone may leave the main source of suffering untouched.
The practical implication is a broader care model. The investigators concluded that routine screening for chronic overlapping pain conditions and targeted non-opioid multimodal interventions are crucial, especially for common dyads. For patients, that points to care that combines rheumatology with pain medicine, physical therapy and behavioral health rather than forcing each clinic to treat one piece of the problem in isolation.
The new data build on earlier rheumatology research from Stanford that found the problem was already widespread in clinic populations. In that 2010-2020 study of 5,992 rheumatology patients, 36% to 62% had a concomitant chronic overlapping pain condition, with Sjögren’s syndrome showing the highest prevalence at 62%. Black patients had the highest prevalence of one or more chronic overlapping pain conditions, while Asian patients had the lowest. Patients with these conditions also had more depression and anxiety, along with more emergency department visits, surgeries and hospitalizations.
The broader public-health burden is large. The NIH Pain Consortium recognizes 10 chronic overlapping pain conditions, and the Chronic Pain Research Alliance says they affect millions of Americans and predominantly affect women. CDC data show chronic pain has already affected about 50 million U.S. adults and more recent estimates put the number near 60 million, including about 21 million with high-impact chronic pain. For rheumatology, that makes the hidden burden impossible to ignore.
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