Central sensitization in rheumatoid arthritis: a cross-sectional analysis of functional disability, disease activity, and glucocorticoid use

Objective To examine the clinical correlates of central sensitization (CS) in patients with rheumatoid arthritis (RA) and to perform an exploratory analysis of its association with glucocorticoid use.Methods This single-center, cross-sectional study included 286 patients with RA (≥18 years) fulfilling the 2010 EULAR/ACR classification criteria and receiving stable treatment for at least 3 months. Demographic data, clinical characteristics, and treatment history were recorded. Participants completed the Central Sensitization Inventory (CSI) and the Fibromyalgia Impact Questionnaire (FIQ). Multivariable logistic regression was performed to identify factors independently associated with CS.Results CS was present in 31.5% (n = 90) of patients. Patients with CS exhibited significantly higher tender joint counts and DAS28-CRP scores, while CRP levels and swollen joint counts were comparable between groups. In univariable analyses, CS was associated with younger age, female sex, longer disease duration, greater biologic exposure, and more frequent current steroid use (54.4% vs. 34.7%, p = 0.002). Multivariable logistic regression revealed that higher HAQ scores remained the sole independent factor associated with CS (OR: 5.32, p < 0.001), whereas the initial association with corticosteroid use lost significance after adjustment.Conclusion CS in RA is independently linked to functional disability rather than objective inflammation, highlighting a potential discordance between clinical findings and symptom burden. Recognition of these non-inflammatory mechanisms may help prevent unnecessary treatment escalation, particularly glucocorticoid overuse, and support more appropriate pain management strategies.