Ab0787 exploration of Pain Syndrome in Patients With Ankylosing Spondylitis With Anxiety-Depressive Spectrum Disorders

Abstract

BackgroundTo date, it has been established that anxiety-depressive spectrum disorders (ADSD) increase the perception of chronic pain. ADSD, as well as immuno-inflammatory diseases, in particular ankylosing spondylitis (AS), are caused by increased production of pro-inflammatory cytokines. Cytokines activate the hypothalamic-pituitary-adrenal system, and chronic stress factors provide a new release of cytokines with its subsequent sensitization, impairing the adaptive capabilities of the body, thereby exacerbating endocrine dysfunction that regulates stress and immune response in the body, which increases the level of proinflammatory cytokines, and is clinically manifested by a decrease in mood, chronic pain, fatigue, sleep disorders.ObjectivesTo study the features of pain syndrome in patients with ankylosing spondylitis with anxiety-depressive spectrum disorders.MethodsThe exploration involved 112 patients with AS, aged 25 to 58 years (43.7±7.9 years), the average duration of the disease was 9.5±4.4 years. 67 of them (group 1) showed signs of ADSD, established by the Spielberger anxiety and Hamilton depression scales. The remaining 45 patients without ADSD were included in the 2nd observation group. The patients in the groups did not differ in age (p=0.67), however, they differed in the duration of the disease (p=0.035) - in the 1st group 10.2±4.5, in the 2nd group 8.4±4.0 years. In addition, patients of the 1st and 2nd groups did not differ in the frequency of occurrence of chronic fatigue (p=0.2) and decreased mood (p=0.08). However, sleep disorders (difficulty falling asleep, shallow sleep, early awakening) were significantly more frequent in-group 1 (p=0.046). Quantitative indicators of pain syndrome (PS) were studied using the McGill Pain Questionnaire (MGPQ). The severity of pain in the spine, morning stiffness, the patient’s state of health (PSH) were studied using visual analog scales (VAS); BASDAI and BASFI indices, ESR and CRP indices were also recorded.ResultsPatients in the groups did not differ in BASDAI indices - in group 1, 4.04±1.24, in group 2, 3.83±0.98 and BASFI - 4.21±0.99 and 4.24±0.84, respectively; there were also no differences in the level of CRP and ESR. Spinal pain in group 1 (67.8±17.5 mm) was significantly stronger (p=0.02) than in group 2 (60.2±15.9 mm), morning stiffness was also significantly (p=0.028) more pronounced in group 1 (67.4±15.9 mm) than in group 2 (60.3±17.2 mm). According to the indicator of SPP, a more negative tendency to its increase should be noted in the 1st group (68.7±15.2 mm) than in the 2nd (63.7±14.4 mm), but without significant differences (p=0.084). All quantitative indicators of BS according to the ICD in the groups had significant differences (p<0.05), reaching maximum significance for the sensory and affective components of pain, the index of the number of selected descriptors (INSD). Namely: in group 1, the number of sensory and affective class descriptors was 5.9±0.8 and 4.5±0.7, the evaluative component of pain was 2.9±0.5, INSD was 11.9±1.4 points, the pain rank index (PRI) was 26.3±5.5 points; in group 2, the number of sensory and affective descriptors was 5.0±0.9 and 3.75±0.6, evaluative - 2.6±0.6, INSD - 10.3±1.5, RIB - 21.2±5.1 points. A higher number of affective class descriptors and ICPD in group 1 indicates the emotional lability of patients with ADSD and to a certain extent explains the significantly more significant negative indicators of BS recorded during the survey using VAS.ConclusionSignificantly higher quantitative indicators of BS in patients with AS with ADSD confirm the presence in this category of patients of a pronounced emotional-affective component of pain, which has a central origin, and contributes to the growth of its somatic perception.Disclosure of InterestsNone declared