Is central sensitization an important determinant of functional disability in patients with chronic inflammatory arthritides?

Abstract

Background: Central sensitization (CS) is a condition characterized by a disproportionate response to pain stimuli. We sought to investigate the prevalence of CS in patients with inflammatory arthritides and its association with measures of disease activity and functional disability. Methods: We conducted an observational retrospective study in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) patients. We administered to all the subjects in the study the CS inventory (CSI), a questionnaire that has been used for the diagnosis of CS. Demographic and clinical characteristics were collected as well as measures or disease activity [i.e. Simple Disease Activity Index, Disease Activity Score in PsA (DAPSA)] and functional disability [Health Assessment Questionnaire Disability Index (HAQ-DI)]. Patients with fibromyalgia were excluded from the analyses. The primary outcome measure was the presence of functional disability as assessed by HAQ-DI >1. Results: We enrolled 150 patients with inflammatory arthritides (78 PsA and 72 RA). Prevalence of CS was observed in 35.3% of the overall sample (29% in RA, 42.9% in PsA). Binary logistic regressions showed a strong, independent and linear association between functional disability and CS in both PsA and RA patients. The strength of this association was greater in PsA than in RA. Conclusion: CS is an important determinant of functional disability in patients with chronic inflammatory arthritides. PsA appeared to be more vulnerable to CS. In addition, in the presence of CS, DAPSA did not adequately capture the occurrence of functional disability. Therefore, special attention should be paid to PsA patients, in whom the concomitant diagnosis of CS should be routinely ruled out.

Evaluation of the effectiveness of Tofacitinib in rheumatoid arthritis in real clinical practice: The relationship between pain relief in the first 4 weeks and disease activity after 3–6 months

“…Как было представлено выше, через ВСП JAK/STAT происходит активация клеток, участвующих в развитии аутоиммунного воспаления, а также экспрессия генов, ответственных за синтез биологически активных субстанций, участвующих в формировании периферической гипералгезии и ЦС -циклооксигеназы 2, матриксной простагландин Е2-синтетазы, матриксных металлопротеиназ (ММП), субстанции Р, фактора роста нервов, и др. Блокада данного ВСП препятствует развитию цитокин-опосредованных нейропластических изменений ноцицептивных нейронов -в частности связанных с гиперпродукцией интерлейкина 6 и затрагивающих как задние рога спинного мозга, так и вышележащие отделы нервной системы [6][7][8].…”

“…Высокая важнейшего элемента патогенеза хронической боли, феномена центральной сенситизации (ЦС) -функциональных изменений ноцицептивной системы, существенно повышающих возбудимость нейронов и снижающих болевой порог [6][7][8]. Ранее нами была представлена работа, в которой исследовалось влияние ТОФА на боль и ЦС при РА [9].…”

Demographic and Clinical Factors Associated with Patient-Reported Remission in Psoriatic Arthritis

“…For example, a complete absence of disease activity may be achievable in patients with early signs of PsA and limited joint damage but may not be realistic in patients with a more established disease with irreversible damage. There may also be a substantial pain component that does not track with improvement in inflammation and that activates central sensitization pathways [ 5 ]. Thus, allowing patients to define remission of their disease becomes more important.…”

Generalized pain hypersensitivity and associated factors in gout

“…Central sensitization typically manifests as general hypersensitivity of the pain system, including allodynia, (secondary) hyperalgesia and aftersensations [ 12 ]. Previous studies have suggested that up to 40–45% of patients with inflammatory arthritides display signs of central sensitization, which is generally not associated with objective parameters of inflammation or disease activity [ 7 , 8 , 13 ].…”

“…As pain due to central sensitization does not respond well to traditional anti-inflammatory medications such as those typically used in gout treatment and may have a serious negative impact on functionality and quality of life [ 13 , 14 ], it is important to examine if and to what extent central pain processing may also play a role in gout. To date, the characteristics of non-inflammatory pain and potential pain sensitization have not yet been investigated in gout [ 5 ].…”