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Is neuropathic pain an overlooked symptom in axial spondyloarthritis?

Year 2022, Volume: 47 Issue: 3, 1033 - 1039, 30.09.2022
https://doi.org/10.17826/cumj.1096777

Abstract

Purpose: Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatologic disease. Pain is the most common symptom affecting quality of life in axSpA patients. It has been showed that pain is not always correlated with inflammation in patients. The aim of our study was to investigate the frequency of neuropathic pain in axSpA patients and relationship between neuropathic pain and patient characteristics.
Materials and Methods: Patients diagnosed as axSpA according to the Assessment of SpondyloArthritis International Society classification criteria, who presented in our outpatients clinics from January to March 2019 were included in this study. The neuropathic component of pain was evaluated with Douleur Neuropathique en 4 Questions (DN4) questionnaire.
Results: Eighty seven axSpA patients were included in the study. Thirty of patients had neuropathic pain according to DN4 questionnaire (DN4>4). Neuropathic pain was higher in active disease group depending on both of ASDAS-CRP and BASDAI. DN4 score of patients was found moderately correlated with ASDAS-CRP and BASDAI score. A weak positive correlation was found between patients education level and DN4 score.
Conclusion: We showed that neuropathic pain could be seen in patients with axSpA and it could be correlated with disease activity. The studies have proven that neuropathic pain could lead to impaired quality of life and social & emotional functions. Patients with neuropathic pain could not benefit from antiinflammatory treatments. Therefore evaluating of neuropathic pain is important in axSpA patients. Further studies on management of neuropathic pain in axSpA patients are needed.

References

  • 1. McDougall JJ. Arthritis and pain. Neurogenic origin of joint pain. Arthritis research & therapy. 2006;8(6):1-10.
  • 2. Rifbjerg-Madsen S, Christensen A, Christensen R, Hetland ML, Bliddal H, Kristensen L, et al. Pain and pain mechanisms in patients with inflammatory arthritis: a Danish nationwide cross-sectional DANBIO registry survey. PLoS One. 2017;12(7):e0180014.
  • 3. Kim T, Son S, Lee J. Neuropathic pain in ankylosing spondylitis: a meta-analysis. Zeitschrift für Rheumatologie. 2020;79(1):95-102.
  • 4. Wu Q, Inman RD, Davis KD. Neuropathic pain in ankylosing spondylitis: a psychophysics and brain imaging study. Arthritis & Rheumatism. 2013;65(6):1494-503.
  • 5. Gok K, Cengiz G, Erol K, Ozgocmen S. Neuropathic pain component in axial spondyloarthritis and the influence on disease burden. JCR: Journal of Clinical Rheumatology. 2018;24(6):324-7.
  • 6. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). pain. 2005;114(1-2):29-36.
  • 7. Unal-Cevik I, Sarioglu-Ay S, Evcik D. A comparison of the DN4 and LANSS questionnaires in the assessment of neuropathic pain: validity and reliability of the Turkish version of DN4. The Journal of Pain. 2010;11(11):1129-35.
  • 8. Lee Y, Song G. Janus kinase inhibitors for treating active ankylosing spondylitis: a meta-analysis of randomized controlled trials. Zeitschrift für Rheumatologie. 2020:1-6.
  • 9. Gauffin J, Hankama T, Kautiainen H, Hannonen P, Haanpää M. Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study. BMC neurology. 2013;13(1):1-6.
  • 10. Zhou L, Li T, Wu X, Lu H, Lin L, Ye L, et al. Assessment of Neuropathic Pain in Ankylosing Spondylitis: Prevalence and Characteristics. Pain and Therapy. 2021;10(2):1467-79.
  • 11. Choi J-H, Lee S-H, Kim H-R, Lee K-A. Association of neuropathic-like pain characteristics with clinical and radiographic features in patients with ankylosing spondylitis. Clinical rheumatology. 2018;37(11):3077-86.
  • 12. Garip Y, Filiz E, KILIÇARSLAN A, Bodur H. Prevalence of neuropathic pain in rheumatic disorders: association with disease activity, functional status and quality of life. Archives of Rheumatology. 2015;30(3):231-7.
  • 13. Li T, Liu Y, Sheng R, Yin J, Wu X, Xu H. Correlation between chronic pain acceptance and clinical variables in ankylosing spondylitis and its prediction role for biologics treatment. Frontiers in medicine. 2020;7:17.
  • 14. Borman P, Kaygisiz F, Yaman A. Neuropathic component of low back pain in patients with ankylosing spondylitis. Modern Rheumatology. 2021;31(2):462-7.
  • 15. KÜLCÜ DG, Batibay S, ACHMET GÖCC, Mesci N. The association of neuropathic pain and disease activity, functional level, and quality of life in patients with ankylosing spondylitis: a cross-sectional study. Turkish journal of medical sciences. 2018;48(2):257-65.
  • 16. Di Carlo M, Cesaroni P, Salaffi F. Neuropathic pain features suggestive of small fibre neuropathy in fibromyalgia syndrome: a clinical and ultrasonographic study on female patients. Clinical and experimental rheumatology. 2021;39(3):S102-S7.
  • 17. Grashorn W, Sprenger C, Forkmann K, Wrobel N, Bingel U. Age-dependent decline of endogenous pain control: exploring the effect of expectation and depression. PloS one. 2013;8(9):e75629.
  • 18. Bán EG, Brassai A, Vizi ES. The role of the endogenous neurotransmitters associated with neuropathic pain and in the opioid crisis: The innate pain-relieving system. Brain Research Bulletin. 2020;155:129-36.
  • 19. Hagberg M, Hagner I-M, Bjelle A. Shoulder muscle strength, endurance and electromyographic fatigue in ankylosing spondylitis. Scandinavian journal of rheumatology. 1987;16(3):161-5.
  • 20. Cooper R, Freemont A, Fitzmaurice R, Alani S, Jayson M. Paraspinal muscle fibrosis: a specific pathological component in ankylosing spondylitis. Annals of the rheumatic diseases. 1991;50(11):755-9.
  • 21. Khedr EM, Rashad SM, Hamed SA, El-Zharaa F, Abdalla AKH. Neurological complications of ankylosing spondylitis: neurophysiological assessment. Rheumatology international. 2009;29(9):1031-40.

Nöropatik ağrı aksiyal spondiloartritte gözden kaçan bir semptom mu?

Year 2022, Volume: 47 Issue: 3, 1033 - 1039, 30.09.2022
https://doi.org/10.17826/cumj.1096777

Abstract

Amaç: Aksiyal spondiloartitler (axSpA) kronik inflamatuar romatolojik hastalıklardan olup ağrı yaşam kalitelerini etkileyen en sık semptomdur. Literatürde ağrının her zaman inflamasyonla korele olmadığı gösterilmiştir. Bu çalışma ile aksiyal spondiloartrit hastalarında nöropatik ağrının frekansının gösterilmesi ve nöropatik ağrı ile hasta özelliklerinin arasındaki ilişkinin gösterilmesi amaçlanmıştır.
Gereç ve Yöntem: Kliniğimizde Ocak- Mart 2019 ayları arasında takip edilen, Assessment of SpondyloArthritis International Society klasifikasyon kriterlerine göre axSpA kabul edilen hastalar çalışmaya dahil edilmiştir. Nöropatik ağrı Douleur Neuropathique en 4 Questions (DN4) ölçeği ile değerlendirildi.
Bulgular: Seksen yedi axSpa hastası çalışmaya dahil edildi. Hastaların 30’unda DN4 ölçeğine göre (DN4 >4) nöropatik ağrı var kabul edildi. Nöropatik ağrı aktif hasta grubunda (ASDAS- CRP ve BASDAI’ ye göre) daha fazla saptandı. DN4 skoru ASDAS- CRP ve BASDAI skoru ile orta düzeyde korele saptandı. Hasta eğitim düzeyi ile DN4 skoru arasında hafif düzeyde korelasyon saptandı.
Sonuç: Çalışmamızda axSpA hastalarında inflamatuvar ağrıya ek olarak nöropatik ağrının görülebileceği ve hastalık aktivitesi ile korele olabileceği gösterildi. Nöropatik ağrı hastaların yaşam kalitesini bozduğu, sosyal ve emosyonel bozukluklara yol açtığı literatürde gösterilmiştir. Hastalar standart anti inflamatuvar tedavi yaklaşımlarından fayda görmeyebilir. AxSpA hastalarında nöropatik ağrının değerlendirilmesi önem kazanmaktadır. AxSpA hastalarında nöropatik ağrının tanı ve tedavi sürecinde ileri çalışmalara gereksinim duyulmaktadır.

References

  • 1. McDougall JJ. Arthritis and pain. Neurogenic origin of joint pain. Arthritis research & therapy. 2006;8(6):1-10.
  • 2. Rifbjerg-Madsen S, Christensen A, Christensen R, Hetland ML, Bliddal H, Kristensen L, et al. Pain and pain mechanisms in patients with inflammatory arthritis: a Danish nationwide cross-sectional DANBIO registry survey. PLoS One. 2017;12(7):e0180014.
  • 3. Kim T, Son S, Lee J. Neuropathic pain in ankylosing spondylitis: a meta-analysis. Zeitschrift für Rheumatologie. 2020;79(1):95-102.
  • 4. Wu Q, Inman RD, Davis KD. Neuropathic pain in ankylosing spondylitis: a psychophysics and brain imaging study. Arthritis & Rheumatism. 2013;65(6):1494-503.
  • 5. Gok K, Cengiz G, Erol K, Ozgocmen S. Neuropathic pain component in axial spondyloarthritis and the influence on disease burden. JCR: Journal of Clinical Rheumatology. 2018;24(6):324-7.
  • 6. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). pain. 2005;114(1-2):29-36.
  • 7. Unal-Cevik I, Sarioglu-Ay S, Evcik D. A comparison of the DN4 and LANSS questionnaires in the assessment of neuropathic pain: validity and reliability of the Turkish version of DN4. The Journal of Pain. 2010;11(11):1129-35.
  • 8. Lee Y, Song G. Janus kinase inhibitors for treating active ankylosing spondylitis: a meta-analysis of randomized controlled trials. Zeitschrift für Rheumatologie. 2020:1-6.
  • 9. Gauffin J, Hankama T, Kautiainen H, Hannonen P, Haanpää M. Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study. BMC neurology. 2013;13(1):1-6.
  • 10. Zhou L, Li T, Wu X, Lu H, Lin L, Ye L, et al. Assessment of Neuropathic Pain in Ankylosing Spondylitis: Prevalence and Characteristics. Pain and Therapy. 2021;10(2):1467-79.
  • 11. Choi J-H, Lee S-H, Kim H-R, Lee K-A. Association of neuropathic-like pain characteristics with clinical and radiographic features in patients with ankylosing spondylitis. Clinical rheumatology. 2018;37(11):3077-86.
  • 12. Garip Y, Filiz E, KILIÇARSLAN A, Bodur H. Prevalence of neuropathic pain in rheumatic disorders: association with disease activity, functional status and quality of life. Archives of Rheumatology. 2015;30(3):231-7.
  • 13. Li T, Liu Y, Sheng R, Yin J, Wu X, Xu H. Correlation between chronic pain acceptance and clinical variables in ankylosing spondylitis and its prediction role for biologics treatment. Frontiers in medicine. 2020;7:17.
  • 14. Borman P, Kaygisiz F, Yaman A. Neuropathic component of low back pain in patients with ankylosing spondylitis. Modern Rheumatology. 2021;31(2):462-7.
  • 15. KÜLCÜ DG, Batibay S, ACHMET GÖCC, Mesci N. The association of neuropathic pain and disease activity, functional level, and quality of life in patients with ankylosing spondylitis: a cross-sectional study. Turkish journal of medical sciences. 2018;48(2):257-65.
  • 16. Di Carlo M, Cesaroni P, Salaffi F. Neuropathic pain features suggestive of small fibre neuropathy in fibromyalgia syndrome: a clinical and ultrasonographic study on female patients. Clinical and experimental rheumatology. 2021;39(3):S102-S7.
  • 17. Grashorn W, Sprenger C, Forkmann K, Wrobel N, Bingel U. Age-dependent decline of endogenous pain control: exploring the effect of expectation and depression. PloS one. 2013;8(9):e75629.
  • 18. Bán EG, Brassai A, Vizi ES. The role of the endogenous neurotransmitters associated with neuropathic pain and in the opioid crisis: The innate pain-relieving system. Brain Research Bulletin. 2020;155:129-36.
  • 19. Hagberg M, Hagner I-M, Bjelle A. Shoulder muscle strength, endurance and electromyographic fatigue in ankylosing spondylitis. Scandinavian journal of rheumatology. 1987;16(3):161-5.
  • 20. Cooper R, Freemont A, Fitzmaurice R, Alani S, Jayson M. Paraspinal muscle fibrosis: a specific pathological component in ankylosing spondylitis. Annals of the rheumatic diseases. 1991;50(11):755-9.
  • 21. Khedr EM, Rashad SM, Hamed SA, El-Zharaa F, Abdalla AKH. Neurological complications of ankylosing spondylitis: neurophysiological assessment. Rheumatology international. 2009;29(9):1031-40.
There are 21 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Esra Kayacan Erdoğan 0000-0002-3570-875X

İpek Türk 0000-0001-5192-9045

Publication Date September 30, 2022
Acceptance Date July 17, 2022
Published in Issue Year 2022 Volume: 47 Issue: 3

Cite

MLA Kayacan Erdoğan, Esra and İpek Türk. “Is Neuropathic Pain an Overlooked Symptom in Axial Spondyloarthritis?”. Cukurova Medical Journal, vol. 47, no. 3, 2022, pp. 1033-9, doi:10.17826/cumj.1096777.