Prevalence of chronic widespread pain in a population-based cohort of patients with spondyloarthritis – a cross-sectional study

Abstract

Background Chronic pain, regional or widespread, is a frequent and multidimensional symptom in arthritis. There is still limited information on chronic pain in spondyloarthritis, which is important to recognize for adequate diagnosis and treatment. Our objective was to study differences in prevalence of chronic widespread pain in two spondyloarthritis subgroups: ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA). Methods A population-based postal survey involving questions on the duration, distribution, and intensity of pain was answered by 940 patients with AS (ICD-10 M45.9) or USpA (ICD-10 M46.1-0, M46.8-9). The patients were categorized as having chronic widespread pain, chronic regional pain, or no chronic pain, and prevalence estimates for the pain groups were calculated, including age- and sex-adjusted prevalence. Results The prevalence of chronic widespread pain was 45.3% in AS vs. 49.3% in USpA, and that of chronic regional pain was 17.7% vs. 21.9% ( p = 0.033). More women than men reported having chronic widespread pain (54.1% vs. 41.2%, p ≤ 0.001), while the sex distribution for chronic regional pain was equal. Reports of pain intensity were equal in AS and USpA, with no significant difference in pain intensity between women and men who had chronic regional pain or chronic widespread pain. In the multiple logistic regression analysis, chronic widespread pain was associated to female sex, being an ever-smoker, and having a higher body mass index, controlled for SpA subgroup and disease duration. Conclusions The prevalence of chronic widespread pain in patients with AS and USpA is high, and with a female predominance, but with no difference in pain intensity between women and men. Chronic pain can complicate the clinical evaluation in patients with SpA, and highlights the need for a thorough clinical examination, including evaluation of inflammation and an accurate pain analysis, to individualize non-pharmacological and pharmacological treatment decisions.

Differences between men and women with nonradiographic axial spondyloarthritis: clinical characteristics and treatment effectiveness in a real-life prospective cohort

“…The most important difference between men and women in nr-axSpA related to the BASDAI, as a patient-reported disease activity outcome. The amplitude of this difference was slightly lowered by exclusion of nr-axSpA patients with co-morbid fibromyalgia, which was more commonly seen in women, confirming previous analyses [ 30 – 32 ]. We cannot entirely exclude the possibility that diagnosis of concurrent fibromyalgia might have been missed in some patients, as clinical differentiation between enthesitis and allodynia of fibromyalgia might be challenging in clinical practice.…”

Socio-demographic determinants in the evolution of pain in inflammatory rheumatic diseases: results from ESPOIR and DESIR cohorts

“…Sex-attributed differences in pain [ 16 , 24 ], disease activity [ 35 ], treatment response [ 36 ], and quality of life [ 37 ] are known in IRDs. In accordance with past findings [ 15 , 38 ], women in this study with SpA reported higher crude pain scores compared with men ( Supplementary Tables S10–S12 , available at Rheumatology online). However, adjustment for disease-specific characteristics (inflammatory and clinical markers) attenuated the observed sex differences in pain in early IRD.…”

Risk factors for development and persistence of chronic widespread pain in spondyloarthritis: a population-based two-year follow-up study

“…In addition to having continuous peripheral inflammatory input that can cause increased sensitivity in peripheral nociceptors, some individuals may also develop a central sensitization, resulting in hyperalgesia and allodynia (23,24). This could partly explain the high prevalence of CWP (34%) reported in patients with rheumatoid arthritis (RA) (25), and our own previous findings were that almost half (47%) of the patients with AS and USpA reported coexisting CWP (26). According to previous research, increasing pain intensity and spread of pain in multiple body regions, together with psychological and social factors, can result in CWP (27)(28)(29).…”