Are gabapentin and baclofen suitable for treating rheumatoid arthritis?

Gabapentin and Baclofen Are Not Appropriate for Rheumatoid Arthritis

Neither gabapentin nor baclofen should be used for rheumatoid arthritis—baclofen is explicitly contraindicated per FDA labeling, and gabapentin lacks evidence of efficacy for RA pain.

FDA-Approved Indications

• Baclofen is specifically NOT indicated for rheumatic disorders: The FDA label explicitly states "Baclofen tablets are not indicated in the treatment of skeletal muscle spasm resulting from rheumatic disorders" 1
• Baclofen is only approved for spasticity from multiple sclerosis and spinal cord diseases, not inflammatory arthritis 1
• Gabapentin has no FDA approval for RA and is only indicated for neuropathic pain conditions (diabetic neuropathy, post-herpetic neuralgia) 2

Evidence Base for Pain Management in RA

• No evidence supports gabapentin for RA pain: A comprehensive 2012 Cochrane review of neuromodulators in RA found no trials evaluating gabapentin or pregabalin specifically in RA patients 3
• A 2025 systematic review confirmed low-quality evidence that gabapentinoids provide pain improvements in RA, with no supportive evidence for their use 4
• The only neuromodulators with any (weak) evidence in RA are topical capsaicin, oral nefopam, and oromucosal cannabis—not gabapentin or baclofen 3

Guideline-Recommended Approach to RA Pain

The correct treatment algorithm for RA pain prioritizes disease control, not symptom masking:

1. First-line: Disease-modifying therapy - Methotrexate 20-25 mg weekly as initial DMARD to address the underlying inflammatory disease 2, 5
2. Short-term adjuncts during flares - NSAIDs or short-term glucocorticoids for acute pain/inflammation 2
3. If inadequate response - Escalate to biologic DMARDs or targeted synthetic DMARDs, not neuromodulators 2, 5
4. For persistent pain despite disease control - Consider duloxetine (the only centrally-acting agent with adequate evidence in arthritis pain) 2

Why This Matters Clinically

• Gabapentinoid prescribing in RA has risen dramatically despite lack of evidence—from <1% in 2004 to approximately 10% in 2020 in England, representing an evidence-to-practice gap 4
• Using ineffective medications delays appropriate DMARD therapy, which can lead to irreversible joint damage 5, 6
• The 2016 CDC guideline notes gabapentin is effective for neuropathic pain (diabetic neuropathy, post-herpetic neuralgia) but does not mention inflammatory arthritis as an indication 2

Common Pitfall to Avoid

Do not treat RA pain with neuromodulators or muscle relaxants when the underlying disease is inadequately controlled. Pain in RA reflects active inflammation requiring DMARDs, not symptomatic agents designed for neuropathic pain or spasticity 2, 5, 4. The appropriate response to persistent RA pain is treatment escalation with DMARDs/biologics using a treat-to-target approach, not adding gabapentin or baclofen 2, 6.