Central Sensitization in Spondyloarthritis: The Crossroads between Disease Activity, Health-related Quality of Life and Fibromyalgia

Abstract

Objective: To assess central sensitization in young patients with spondyloarthritis (SpA) and to study the associated factors with higher central sensitization scores. Methods: This was a cross-sectional study including patients with SpA (ASAS criteria) aged less than 50 years. For all patients, we collected the sociodemographic and disease characteristics data. Central sensitization was assessed using a validated tool: The Central Sensitization inventory (CSI). Pain status, fibromyalgia, quality of life, anxiety and depression were screened by the Brief pain inventory, the Fibromyalgia rapid screening tool (FiRST), the ASQoL, and the Hospital anxiety and depression scale (HAD) anxiety and depression. Univariable and multivariable linear regression analyses were performed to achieve our objective. objective: To assess the central sensitization in young patients with spondyloarthritis (SpA) and to study the associated factors with higher central sensitization scores. Results: Seventy-two patients were enrolled (65,2% males). The median age was 39 (28,25–46) years. Median BASDAI and ASDAS-CRP scores were 3 (2.1 - 4.7) and 2.7 (1.9 - 3.48), respectively. The median value of the CSI score was 15 (6,25–33,75); a CSI≥40 was noted in 15.3% of patients. Depression, anxiety scores, fibromyalgia and impaired QoL were screened in 11%, 9,7%, 9,7%, and 44,4%, respectively. CSI≥40 was positively correlated with ASQoL, FiRST, HAD anxiety, HAD depression and the 5 categories of pain interference (mood, regular work, relationships, sleep and enjoyment of life). Multivariate analysis identified a predictive model which included the combination of FiRST, BASDAI and ASQoL. First was the strongest predictive factor of a higher central sensitization. Conclusion: CS is frequent among SpA patients and should be looked for in order to improve QoL. result: Seventy-two patients were enrolled (65,2% males). Median age was 39 (28,25–46) years. Median BASDAI and ASDAS-CRP scores were 3 (2.1 - 4.7) and 2.7 (1.9 - 3.48), respectively. The median value of the CSI score was 15 (6,25–33,75); a CSI≥40 was revealed in 15.3% of patients. Depression, anxiety scores, fibromyalgia and impaired QoL were screened in 11%, 9,7%, 9,7%, and 44,4%, respectively. CSI≥40 was positively correlated with ASQoL, FiRST, HAD anxiety, HAD depression and the 5 categories of pain interference (mood, regular work, relationships, sleep and enjoyment of life). Multivariate analysis identified a predictive model which included the combination of FiRST, BASDAI and ASQoL. FiRST was the strongest predictive factor of a higher central sensitization.

Validation of the Fibromyalgia Rapid Screening Tool in patients with axial spondyloarthritis: Polish version adaptation and value in clinical practice

“…These results suggest that the limited sensitivity and, to a lesser extent, specificity of FiRST are probably due to differences in the perception of FM-related symptoms in patients with axSpA compared to other patients with chronic widespread pain. What seems disturbing is the widespread use of FiRST for diagnosing FM in axSpA patients in scientific research [19][20][21][22][23][24]. In studies with large patient groups, it may be tempting to use a short and simple PROM rather than a full clinical assessment.…”

“…However, there is no Polish language version of FiRST. Moreover, although FiRST is often used in studies with axSpA patients to determine the prevalence of FM [19][20][21][22][23][24], it has never really been validated in this group of patients. We found only one study with axSpA patients that have used FIRST and 1990 ACR classification criteria at the same time, and which have shown rather poor agreement between the screening test and the classification criteria (with κ coefficient = 0.35) [5].…”

REAC Neurobiological Modulation as a Precision Medicine Treatment for Fibromyalgia

“…This sensitivity may be due to alterations in the way that pain signals are processed in the central nervous system. Studies have shown that individuals with fibromyalgia have changes in the way that their brains respond to pain stimuli [ 2 , 3 , 99 , 102 , 103 , 104 , 105 ], which may contribute to the heightened pain sensitivity and chronic pain experienced by these individuals.…”