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O'Brien JA, Austin PJ. Minocycline Abrogates Individual Differences in Nerve Injury-Evoked Affective Disturbances in Male Rats and Prevents Associated Supraspinal Neuroinflammation. J Neuroimmune Pharmacol 2024; 19:30. [PMID: 38878098 PMCID: PMC11180027 DOI: 10.1007/s11481-024-10132-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 06/08/2024] [Indexed: 06/19/2024]
Abstract
Chronic neuropathic pain precipitates a complex range of affective and behavioural disturbances that differ markedly between individuals. While the reasons for differences in pain-related disability are not well understood, supraspinal neuroimmune interactions are implicated. Minocycline has antidepressant effects in humans and attenuates affective disturbances in rodent models of pain, and acts by reducing neuroinflammation in both the spinal cord and brain. Previous studies, however, tend not to investigate how minocycline modulates individual affective responses to nerve injury, or rely on non-naturalistic behavioural paradigms that fail to capture the complexity of rodent behaviour. We investigated the development and resolution of pain-related affective disturbances in nerve-injured male rats by measuring multiple spontaneous ethological endpoints on a longitudinal naturalistic foraging paradigm, and the effect of chronic oral minocycline administration on these changes. Disrupted foraging behaviours appeared in 22% of nerve-injured rats - termed 'affected' rats - and were present at day 14 but partially resolved by day 21 post-injury. Minocycline completely prevented the emergence of an affected subgroup while only partly attenuating mechanical allodynia, dissociating the relationship between pain and affect. This was associated with a lasting downregulation of ΔFosB expression in ventral hippocampal neurons at day 21 post-injury. Markers of microglia-mediated neuroinflammation were not present by day 21, however proinflammatory microglial polarisation was apparent in the medial prefrontal cortex of affected rats and not in CCI minocycline rats. Individual differences in affective disturbances following nerve injury are therefore temporally related to altered microglial morphology and hippocampal neuronal activation, and are abrogated by minocycline.
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Affiliation(s)
- Jayden A O'Brien
- Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Paul J Austin
- Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Philippoteaux C, Marty-Ane A, Cailliau E, Labreuche J, Philippe P, Cortet B, Paccou J, Flipo RM, Letarouilly JG. Characteristics Of Difficult-To-Treat Psoriatic Arthritis: A Comparative Analysis. Semin Arthritis Rheum 2023; 63:152275. [PMID: 37852155 DOI: 10.1016/j.semarthrit.2023.152275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE The EULAR task force recently published the difficult-to-treat rheumatoid arthritis (D2T RA) criteria, however, a definition of D2T patients in psoriatic arthritis (PsA) is still lacking. To date, we have little data concerning D2T PsA, especially in real-world. One of the limitations of the D2T RA EULAR definition is the absence of a temporal criterion. The primary endpoint of this work was to study the characteristics of D2T PsA patients using the EULAR definition. The second objective was to study a sub-group of patients with a predefined more stringent definition including a temporal criterion. METHODS A retrospective study was performed in a tertiary center. D2T PsA was defined as failure of ≥ 2 b/tsDMARDs with different mechanism of action. Very D2T PsA was defined as failure of ≥ 2 b/tsDMARDs in less than 2 years of follow-up. D2T and Very D2T PsA patients were compared to nD2T PsA patients using statistical tests. RESULTS 150 PsA patients were included (from 2004 to 2015): 49 D2T PsA and 101 nD2T PsA. D2T PsA was associated with a higher prevalence of axial involvement (p=0.030), axial and/or peripheral structural damage (p=0.007) at baseline and more bDMARDs discontinuation due to poor dermatological control (p=0.005). There was no significant difference regarding comorbidities such as obesity, smoking status, fibromyalgia or depression. In multivariate analysis, peripheral structural damage at baseline was found to be a predictive factor for D2T PsA with an OR of 2.57 (1.16 to 5.69; p=0.020). 17 PsA (11.3%) patients were categorized as Very D2T PsA. When compared to nD2T group, proportion of obesity was higher (p=0.015) and axial involvement was more prevalent in the Very D2T group (p=0.020). CONCLUSION D2T PsA patients had a higher prevalence of axial involvement, peripheral structural damage and therapeutic discontinuation due to poor dermatological control whereas Very D2T PsA patients were more likely obese with axial involvement. Very D2T PsA represent a minim proportion among patients when applying a more stringent definition. Pending the PsA D2T definition by the European and American societies, this study highlights some characteristics that may help practitioners better identify D2T patients.
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Affiliation(s)
| | - Anne Marty-Ane
- Rheumatology Department, Lille University Hospital, Lille, France
| | - Emeline Cailliau
- Biostatistics Department, Lille University Hospital, Lille, France
| | - Julien Labreuche
- Biostatistics Department, Lille University Hospital, Lille, France
| | - Peggy Philippe
- Rheumatology Department, Lille University Hospital, Lille, France
| | - Bernard Cortet
- Rheumatology Department, Lille University Hospital, Lille, France
| | - Julien Paccou
- Rheumatology Department, Lille University Hospital, Lille, France
| | - Rene-Marc Flipo
- Rheumatology Department, Lille University Hospital, Lille, France
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Liao C, Tan Y, Wang K, Wen X, Hu X, Huang Y, Li Y. The Impact and Correlation of Anxiety and Depression on Pressure Pain Threshold of Acupoints in Patients with Chronic Pelvic Inflammatory Disease. Pain Res Manag 2023; 2023:3315090. [PMID: 38033371 PMCID: PMC10684321 DOI: 10.1155/2023/3315090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/10/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
Background Chronic pelvic inflammatory disease (CPID) is a clinically common gynecological disease. Patients experience chronic pelvic pain and often accompany with emotional dysfunction. However, the impact and correlation of anxiety and depression on pain sensitization is not completely known. Objective To explore the differences and correlations among anxiety, depression, and pressure pain threshold (PPT) of acupoints in patients with CPID. Methods One hundred and forty-seven patients with CPID were recruited. The Visual Analog Scale (VAS) and short-form McGill Pain Questionnaire (SF-MPQ) were used to assess pain. Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate the emotional state of patients. The PPT of acupoints was collected using an electronic Von Frey by two licensed acupuncturists. Results The CPID patients were divided into anxiety-depression group (group A) or nonanxiety-depression group (group B), according to the SAS and SDS scores. Finally, there were 73 patients in group A and 74 patients in group B. Group A had significantly higher SAS, SDS, VAS, and SF-MPQ scores than group B (P < 0.05). In addition, significant differences were observed in the PPTs of ST28 (R), ST29 (R), SP10 (R), SP9 (R), SP9 (L), ST36 (R), and LR3 (L) between the two groups (P < 0.05). No considerable differences in PPTs at the other acupoints were observed between the two groups. SAS scores showed a positive correlation with PPTs of ST29 (R), SP10 (R), SP9 (L), ST36 (R), and LR3 (L). No remarkable correlation was observed between the SDS scores and PPTs. Conclusion Anxiety and depression can affect the PPT of some acupoints in CPID patients, which may provide a reference for acupoint selection for acupuncture treatment of CPID with emotional disorders. This trial is registered with ChiCTR2100052632.
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Affiliation(s)
- Chenxi Liao
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu Tan
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Kai Wang
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin Wen
- Sichuan Second Hospital of Traditional Chinese Medicine, Chengdu, China
| | - Xiang Hu
- Department of Gynecology, The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yefang Huang
- Department of Gynecology, The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ying Li
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Trouvin AP, Simunek A, Coste J, Medkour T, Carvès S, Bouhassira D, Perrot S. Mechanisms of chronic pain in inflammatory rheumatism: the role of descending modulation. Pain 2023; 164:605-612. [PMID: 35984362 DOI: 10.1097/j.pain.0000000000002745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Persistent pain despite satisfactory disease treatment is frequent in rheumatoid arthritis (RA) and spondyloarthritis (Spa) and may result from specific changes in central pain processing. We assessed these mechanisms further by systematically comparing thermal pain thresholds and conditioned pain modulation (CPM) between patients with active RA or Spa and healthy controls. We included 50 patients with RA and 50 patients with Spa and 100 age-matched and sex-matched controls. Heat and cold pain thresholds (HPT-CPT) were measured on the dominant forearm, and CPM was assessed by applying conditioning stimuli (immersion in a cold-water bath) to one foot and the nondominant hand in 2 successive randomized sequences. Descending pain modulation was assessed as the difference in HPTs (in °C) before and after conditioning. Larger HPT differences (ie, a larger CPM effect) reflected more efficient descending inhibition. Potential associations between changes in CPM and clinical data, including disease activity, pain intensity, and psychological and functional variables, were systematically assessed. Heat pain threshold and cold pain threshold were similar in patients and controls. The mean CPM effect was significantly weaker in patients than that in controls for conditioning applied to either the foot (0.25°C ±2.57 vs 2.79°C ±2.31; P < 0.001) or the nondominant hand (0.57°C ±2.74 vs 2.68°C ±2.12; P < 0.001). The smaller CPM effect in patients was correlated with average pain intensity, but not with disease activity or other clinical characteristics, suggesting a significant pathophysiological role for changes in endogenous pain modulation in the mechanisms of chronic pain associated with inflammatory rheumatism.
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Affiliation(s)
- Anne-Priscille Trouvin
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
- Inserm U987, UVSQ, Paris-Saclay University, Boulogne Billancourt, France
| | - Arielle Simunek
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Joël Coste
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
- Biostatistics and Epidemiology Unit, GHU Paris Centre-Cochin, Paris, France
| | - Terkia Medkour
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
- Inserm U987, UVSQ, Paris-Saclay University, Boulogne Billancourt, France
| | - Sandrine Carvès
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Didier Bouhassira
- Inserm U987, UVSQ, Paris-Saclay University, Boulogne Billancourt, France
- Pain Medicine Department, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Serge Perrot
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
- Inserm U987, UVSQ, Paris-Saclay University, Boulogne Billancourt, France
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Steinmetz A, Hacke F, Delank KS. Pressure Pain Thresholds and Central Sensitization in Relation to Psychosocial Predictors of Chronicity in Low Back Pain. Diagnostics (Basel) 2023; 13:diagnostics13040786. [PMID: 36832274 PMCID: PMC9954899 DOI: 10.3390/diagnostics13040786] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
(1) Background: Peripheral, as well as central, sensitization have been described in chronic low back pain (cLBP). The purpose of this study is to investigate the influence of psychosocial factors on the development of central sensitization. (2) Methods: This prospective study investigated local and peripheral pressure pain thresholds and their dependence on psychosocial risk factors in patients with cLBP receiving inpatient multimodal pain therapy. Psychosocial factors were assessed using the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ). (3) Results: A total of 90 patients were included in the study, 61 (75.4% women, 24.6% men) of whom had significant psychosocial risk factors. The control group consisted of 29 patients (62.1% women, 37.9% men). At baseline, patients with psychosocial risk factors showed significantly lower local and peripheral pressure pain thresholds, suggesting central sensitization, compared to the control group. Sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI), was also correlated with altered PPTs. After multimodal therapy, all participants reported increased local pain thresholds compared to at admission, independent of psychosocial chronification factors. (4) Conclusions: Psychosocial chronicity factors measured using the ÖMPSQ have a significant influence on pain sensitization in cLBP. A 14-day multimodal pain therapy increased local, but not peripheral, pressure pain thresholds.
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Affiliation(s)
- Anke Steinmetz
- Physical and Rehabilitation Medicine, Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
- Correspondence: ; Tel.: +49-3834-86-6695
| | - Franziska Hacke
- Department of Geriatrics, Martin-Luther-University Halle-Wittenberg, 06120 Halle/Saale, Germany
| | - Karl-Stefan Delank
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle/Saale, Germany
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Kim HJ, Meeker TJ, Jung JY, Kim JW, Kim HA. Biological sex influences psychological aspects of the biopsychosocial model related to chronic pain intensity and interference among South Korean patients with chronic secondary musculoskeletal pain in rheumatic diseases. Front Psychol 2023; 14:1063164. [PMID: 37138999 PMCID: PMC10150094 DOI: 10.3389/fpsyg.2023.1063164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Pain is a prominent contributor to negative personal and social outcomes, including increased disability and mortality, in many rheumatic diseases. In the Biopsychosocial model of chronic pain, psychological and social factors share roles with the biology of the injury in determining each patient's pain and suffering. The current study explored factors associated with clinical pain intensity and interference among patients with chronic secondary musculoskeletal pain in rheumatic diseases. Methods In total, 220 patients experiencing chronic secondary musculoskeletal pain participated. Biological factors (age, biological sex, pain condition, pain duration, pain sensitivity, and comorbidity), socio-economic factors, psychological factors (pain catastrophizing and depressive symptoms), and pain intensity and interference were measured. Descriptive, multivariable linear regression and partial correlation analyses were conducted. Subgroup analysis by sex was conducted to examine differences in how different factors affect the pain experience. Results The mean age of the participants was 52.3 years (SD = 12.07) and ranged from 22 to 78. Average pain intensity was 3.01 (0-10 scale) and average total pain interference score was 21.07 (0-70 scale). Partial correlation found positive correlations between pain intensity and interference with depression (intensity: R = 0.224; p = 0.0011; interference: R = 0.351; p < 0.001) and pain catastrophizing (intensity: R = 0.520; p < 0.001; interference: R = 0.464; p < 0.001). In males, pain condition (β = -0.249, p = 0.032) and pain catastrophizing (R = 0.480, p < 0.001) were associated with pain intensity. In males, the simple correlation between pain intensity and depression (R = 0.519; p < 0.001) was driven by pain catastrophizing. In females, pain catastrophizing (R = 0.536, p < 0.001) and depressive symptoms (R = 0.228, p = 0.0077) were independently associated with pain intensity. Age (β = -0.251, p = 0.042) and pain catastrophizing (R = 0.609, p < 0.001) were associated with pain interference in males, while depressive symptoms (R = 0.439, p < 0.001) and pain catastrophizing (R = 0.403, p < 0.001) were associated with pain interference in females. Again, in males, the simple correlation between pain interference and depression (R = 0.455; p < 0.001) was driven by pain catastrophizing. Discussion In this study, females were more directly affected by depressive symptoms than males, regarding pain intensity and interference. Pain catastrophizing was a significant factor influencing chronic pain for both males and females. Based on these findings, a sex-specific approach to the Biopsychosocial model should be considered in understanding and managing pain among Asians with chronic secondary musculoskeletal pain.
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Affiliation(s)
- Hee Jun Kim
- School of Nursing, The George Washington University, Washington, DC, United States
- *Correspondence: Hyoun-Ah Kim,
| | - Timothy J. Meeker
- Department of Biology, Morgan State University, Baltimore, MD, United States
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Ji-Won Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon-si, Republic of Korea
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Cengiz F, Günaydin N. How Do Cognition and Emotion Regulation Strategies and Intolerance of Uncertainty Predict the Severity of Fatigue and Daily Life Activities of Rheumatoid Arthritis Patients? JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2022. [DOI: 10.1007/s10942-022-00480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Trouvin AP, Attal N, Perrot S. Assessing central sensitization with quantitative sensory testing in inflammatory rheumatic diseases: a systematic review. Joint Bone Spine 2022; 89:105399. [DOI: 10.1016/j.jbspin.2022.105399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
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Arnstad ED, Iversen JM, Uglem M, Glerup M, Romundstad PR, Sand T, Rygg M. Pain sensitivity in young adults with juvenile idiopathic arthritis: a quantitative sensory testing study. Arthritis Res Ther 2020; 22:262. [PMID: 33153493 PMCID: PMC7643261 DOI: 10.1186/s13075-020-02345-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/05/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To study for the first-time, pain perception, pain sensitivity, and self-reported pain in young adults with long disease duration of juvenile idiopathic arthritis (JIA) compared with controls. METHODS Children from Central Norway diagnosed with JIA between 1997 and 2004 were included consecutively in a population-based prospective study. Children with onset 1997-2000 were part of the Nordic JIA cohort. Controls were age- and sex-matched. In 2015-2017, study visits with investigator-blinded quantitative sensory testing (QST) comprising cold and warm detection thresholds (CDT/WDT), cold and heat pain thresholds (CPT/HPT), pressure pain threshold (PPT), and a suprathreshold heat pain test were performed. We constructed separate multilevel models for each variable of detection and pain thresholds with interaction between groups and site adjusted for the effect of age and sex. RESULTS Among 96 young adults with JIA, 71% were female, median age was 22.7 years, disease duration was 16.1 years, and 47% had oligoarticular disease. Among 109 controls, 71% were female, and median age was 23.5 years. Participants with JIA had lower pressure pain thresholds (PPTs) (95% CI) compared to controls, upper limb 888 (846,930) versus 1029 (999,1059) kPa and lower limb 702 (670,734) versus 760 (726,794) kPa. Participants with inactive disease had the lowest PPTs and cold pain thresholds (CPTs), compared to those in remission off medication and those with active disease. Minor differences were found regarding CDT/WDT and CPT/HPT in JIA compared to controls. The median (IQR) temperature needed to evoke pain = 6 on a 0-10 numeric rating scale (NRS) in the suprathreshold heat pain tests were lower in JIA than in controls (46 °C (45-47 °C) versus 47 °C (46-48 °C)). We found no associations between self-reported pain and pain thresholds. CONCLUSIONS Our results indicate for the first time that young adults with long disease duration of JIA may have altered pain perception and sensitivity compared to controls. A clinical implication may be the importance of early treatment to quickly achieve pain-free remission and avoid long-term pain sensitization.
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Affiliation(s)
- Ellen Dalen Arnstad
- Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
- Department of Clinical and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
| | | | - Martin Uglem
- Department of Neuromedicine and Movement Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Mia Glerup
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Pål Richard Romundstad
- Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
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Patient-Centered Care in Psoriatic Arthritis-A Perspective on Inflammation, Disease Activity, and Psychosocial Factors. J Clin Med 2020; 9:jcm9103103. [PMID: 32992983 PMCID: PMC7600723 DOI: 10.3390/jcm9103103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022] Open
Abstract
Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy characterized by skin lesions, dactylitis, and enthesitis. Patients with PsA suffer from a variety of psychosocial difficulties and nonspecific symptoms early on in the disease course and continue to experience progressive disease due to delays in diagnosis and treatment. Symptoms initially viewed as somatization could lead to undertreatment and promote psychological distress, poor coping, and negative patient-provider relationships. Pain and fatigue are important complaints that affect the patient's perception and may need to be addressed with a multidisciplinary approach. Maladaptive cognitive responses can lead to a negative illness perception and impact patient beliefs and concerns over treatment, as well as nonadherence. An underlying inflammatory component in affective disorders has been examined, though whether and how it may interact mechanistically in PsA warrants interest. Cognitive behavioral therapy represents a nonpharmacological treatment modality that can be combined with cytokine-targeted therapy to address both somatic and psychological complaints. Future directions for research include: (1) Elucidating nonspecific manifestations (e.g., subclinical stage, differential with functional syndromes) of PsA and how they impact diagnosis and management; (2) characterizing immune-mediated components of mood disorders in PsA; and (3) whether a bidirectional approach with abrogating inflammation and psychotherapeutic support leads to improved outcomes.
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11
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Perez-Chada LM, Merola JF. Comorbidities associated with psoriatic arthritis: Review and update. Clin Immunol 2020; 214:108397. [PMID: 32229290 DOI: 10.1016/j.clim.2020.108397] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 02/07/2023]
Abstract
Psoriatic arthritis is an inflammatory arthropathy frequently associated with psoriasis and several other comorbidities. The goal of this review is to summarize the available evidence on the epidemiology, clinical implications, pathological mechanisms proposed, and screening and management recommendations for the comorbidities related with PsA. Reported comorbidities include cardiovascular disease, metabolic syndrome, obesity, diabetes mellitus, dyslipidemia, inflammatory bowel disease, fatty liver disease, uveitis, kidney disease, infections, osteoporosis, depression, central sensitization syndrome, and gout. Given that these comorbidities may affect both clinical outcomes and the management for these patients, their recognition and monitoring by all health-care providers caring for patients with psoriatic arthritis is of utmost importance.
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Affiliation(s)
- Lourdes M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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12
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Epidemiology of depression and anxiety in patients with psoriatic arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2020; 50:1481-1488. [PMID: 32178850 DOI: 10.1016/j.semarthrit.2020.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/21/2020] [Accepted: 02/08/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of the prevalence, incidence, and medication treatment of depression and anxiety among patients with psoriatic arthritis (PsA). METHODS We searched Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO for full-length studies that: utilized an observational design; included patients with PsA with/without a comparator group; evaluated depression and/or anxiety as an outcome, comorbidity, or predictor of a health outcome; and reported relevant estimates. We pooled estimates using random effects models. RESULTS Of 683 titles identified in our search, 18 studies met inclusion criteria. The pooled prevalence proportion for depression based on 11 studies was 17% (95% confidence interval [CI], 13% to 21%). In addition, a meta-analysis of four studies comparing the prevalence of depression in patients with PsA to those without PsA yielded a pooled odds ratio (OR) of 1.68 (95% CI, 1.37 to 2.08). The incidence of depression in PsA patients compared to the general population yielded a pooled incidence rate of 21.27 (95% CI, 16.28 to 26.27) per 1,000 person-years and a pooled incidence rate ratio of 1.44 (95% CI, 1.20 to 1.73). The pooled prevalence proportion of anxiety based on seven studies was 19% (95% CI, 11% to 29%) and a meta-analysis of two studies comparing the prevalence of anxiety in patients with PsA to those without PsA yielded a pooled OR of 1.49 (95% CI, 1.39 to 1.59). Only a small proportion of patients, between 2.4% and 13.5%, were reported to be taking antidepressant or antianxiety medications. CONCLUSIONS We identified substantial prevalence of depression and anxiety as well as elevated incidence of depression among patients with PsA. These findings should raise awareness of the importance of mental health care in this population.
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Kremer M, Becker LJ, Barrot M, Yalcin I. How to study anxiety and depression in rodent models of chronic pain? Eur J Neurosci 2020; 53:236-270. [DOI: 10.1111/ejn.14686] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Mélanie Kremer
- Centre National de la Recherche Scientifique Institut des Neurosciences Cellulaires et Intégratives Université de Strasbourg Strasbourg France
| | - Léa J. Becker
- Centre National de la Recherche Scientifique Institut des Neurosciences Cellulaires et Intégratives Université de Strasbourg Strasbourg France
| | - Michel Barrot
- Centre National de la Recherche Scientifique Institut des Neurosciences Cellulaires et Intégratives Université de Strasbourg Strasbourg France
| | - Ipek Yalcin
- Centre National de la Recherche Scientifique Institut des Neurosciences Cellulaires et Intégratives Université de Strasbourg Strasbourg France
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Treatment of Central Sensitization in Patients With Rheumatoid Arthritis: a Narrative Overview. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Abstract
Active research is being conducted on musculoskeletal pain, and recent concepts will help clinicians and researchers to develop better approaches: -the new pain taxonomy recently has been modified with a third descriptor with the concept of nociplastic pain. -the latest International Classification of Diseases (ICD-11) includes an IASP task force that developed a new classification system for pain. In this new classification, one can differentiate primary musculoskeletal pain including fibromyalgia and low back pain and secondary musculoskeletal pain related to specific etiologies. -the concept of central sensitization in inflammatory rheumatic diseases is increasingly discussed. In these conditions, even with very active biological treatment, almost a third of patients are still complaining of persisting pain. These persisting pain states under adequate treatment, without any sign of inflammation, led researchers to look for evidence of central sensitization states.
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Affiliation(s)
- Anne-Priscille Trouvin
- Unité INSERM U987, Hôpital Ambroise Paré, Paris Descartes University, 9 avenue Charles de Gaulle, 92100, Boulogne Billancourt, France; Centre d'Evaluation et Traitement de la Douleur, Hôpital Cochin, Paris Descartes University, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Serge Perrot
- Unité INSERM U987, Hôpital Ambroise Paré, Paris Descartes University, 9 avenue Charles de Gaulle, 92100, Boulogne Billancourt, France; Centre d'Evaluation et Traitement de la Douleur, Hôpital Cochin, Paris Descartes University, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.
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16
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Højgaard P, Ellegaard K, Nielsen SM, Christensen R, Guldberg-Møller J, Ballegaard C, Dreyer L, Mease P, de Wit M, Skov L, Glintborg B, Bliddal H, Bartels EM, Amris K, Kristensen LE. Pain Mechanisms and Ultrasonic Inflammatory Activity as Prognostic Factors in Patients With Psoriatic Arthritis: A Prospective Cohort Study. Arthritis Care Res (Hoboken) 2019; 71:798-810. [PMID: 29975012 DOI: 10.1002/acr.23693] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/03/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To study the prognostic value of widespread pain and of musculoskeletal ultrasound (US) examination for subsequent treatment outcomes in patients with psoriatic arthritis (PsA). METHODS An exploratory prospective cohort study enrolled patients with PsA initiating biologic or conventional synthetic disease-modifying antirheumatic drugs in routine care. Clinical, US, and patient-reported measures were collected at baseline and after 4 months. Widespread nonarthritic pain (WP) was defined as a Widespread Pain Index score of ≥4 with pain in ≥4 of 5 regions. PsA activity by US was defined as color Doppler (yes/no) in selected entheses, joints, or tendons. The main response criteria included the American College of Rheumatology 20% improvement, the Disease Activity in Psoriatic Arthritis 50% improvement, and minimal disease activity. The primary analyses were age- and sex-adjusted logistic regression. RESULTS WP was present in 24 of 69 included patients (35%) and was associated with worse patient-reported and composite baseline measures, while US and other objective findings were similar to those in patients without WP. The odds of reaching minimal disease activity after 4 months were significantly greater for patients enrolled without WP (odds ratio 18.43 [95% confidence interval 1.51, 224.41]; P = 0.022), while WP did not impair other response measures. Patients with baseline color Doppler activity (n = 42 [61%]) had a worse objective PsA burden, but their chance of treatment response was comparable to those without color Doppler. CONCLUSION More than one-third of patients with PsA presented with WP, which was associated with worse patient-reported scores and failure to achieve minimal disease activity following conventional synthetic or biologic disease-modifying antirheumatic drug therapy. PsA activity by color Doppler US had no influence on subsequent treatment response in this PsA cohort.
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Affiliation(s)
- Pil Højgaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, and Rigshospitalet Gentofte, Hellerup, Denmark
| | - Karen Ellegaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Sabrina Mai Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, and Odense University Hospital, Odense, Denmark, Aalborg, Denmark
| | - Robin Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, and Odense University Hospital, Odense, Denmark, Aalborg, Denmark
| | - Jørgen Guldberg-Møller
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, and Rigshospitalet Gentofte, Hellerup, Denmark
| | - Christine Ballegaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, and Rigshospitalet Gentofte, Hellerup, Denmark
| | - Lene Dreyer
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Rigshospitalet Gentofte, Hellerup, and Aalborg University Hospital, Aalborg, Denmark
| | - Philip Mease
- Swedish Medical Center, University of Washington, Seattle
| | | | - Lone Skov
- Herlev-Gentofte Hospital, Hellerup, Denmark
| | - Bente Glintborg
- Rigshospitalet Gentofte, Hellerup, and Rigshospitalet Glostrup, Glostrup, Denmark
| | - Henning Bliddal
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Else Marie Bartels
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Kirstine Amris
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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Swinnen TW, Westhovens R, Dankaerts W, de Vlam K. Widespread pain in axial spondyloarthritis: clinical importance and gender differences. Arthritis Res Ther 2018; 20:156. [PMID: 30053895 PMCID: PMC6062924 DOI: 10.1186/s13075-018-1626-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is a remarkable lack of detailed knowledge on pain areas in axial spondyloarthritis (axSpA), and their clinical relevance is largely unknown. Pain area may reflect local disease processes, but amplification of nervous system signalling may alter this relationship. Also, gender differences in pain area may exist in axSpA, possibly confounding disease activity outcomes. Therefore, we firstly detailed pain locations in axSpA and evaluated gender differences. Secondly, we explored the relationship of regional pain definitions with clinical outcomes. Finally, we explored the role of pain area in the assessment of disease activity. Methods Body charts informed on the presence of axial, peripheral articular and non-articular pain in 170 patients (108 men, 62 women) with axSpA. Multivariate Odds Ratios (ORs) were used to compare genders. General linear models were used to explore clinical differences in disease activity (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), activity limitations (Bath Ankylosing Spondylitis Functional Index [BASFI]), fear of movement (Tampa Scale for Kinesiophobia 11-item version [TSK-11]), anxiety (Hospital Anxiety and Depression Scale subscale anxiety [HADS-A]) and depression (HADS subscale depression [HADS-D]) between four subgroups classified by widespread non-articular pain (WNAP+/−) and physician global assessment of disease activity (PGDA+/−) (p < .05). Principal Component Analysis (PCA) was performed to explore gender differences in the structure of disease activity. Results Axial thoracic pain was least prevalent (lumbar, 74.4%; cervical, 47.6%; cervicothoracic, 47.6%; thoracic, 32.4%), but it was about three times more likely in women (OR, 2.92; p = .009). Axial cervicothoracic junction pain spread more diffusely in women (OR, 2.48; p = .018). Women exhibited a two- to threefold increased likelihood of widespread axial (OR, 3.33; p = .007) and peripheral articular (OR, 2.34; p = .023) pain. A subgroup of WNAP+/PGDA− combined with low PGDA (27% of all patients) was associated with worse BASFI, BASDAI, HADS-A and HADS-D in men and worse TSK-11 and HADS-A in women (p < .05). Disease activity outcomes showed a two-factor structure in women but not in men. Conclusions In patients with axSpA, the location and spread of pain was different between genders and was related to worse clinical status. On the basis of pain area and PGDA, clinical subgroups exhibiting a remarkably distinct health status were identified. Outcome instruments such as BASDAI should acknowledge gender differences to ensure structural validity. Electronic supplementary material The online version of this article (10.1186/s13075-018-1626-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thijs Willem Swinnen
- Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Herestraat 49 box 7003/13, 3000, Leuven, Belgium. .,Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium.
| | - René Westhovens
- Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Herestraat 49 box 7003/13, 3000, Leuven, Belgium
| | - Wim Dankaerts
- Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium
| | - Kurt de Vlam
- Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Herestraat 49 box 7003/13, 3000, Leuven, Belgium
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18
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Association of neuropathic-like pain characteristics with clinical and radiographic features in patients with ankylosing spondylitis. Clin Rheumatol 2018; 37:3077-3086. [PMID: 29713968 DOI: 10.1007/s10067-018-4125-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/12/2018] [Accepted: 04/24/2018] [Indexed: 02/07/2023]
Abstract
Ankylosing spondylitis (AS) is a chronic, progressive, and inflammatory disorder and causes chronic back pain. It is not unusual for patients with AS to have symptoms similar to neuropathic pain. We aimed to investigate the neuropathic pain (NeP) component in patients with AS using the painDETECT questionnaire (PD-Q) and to assess the relation between NeP and the disease characteristics of AS. A single-center prospective study was performed, including 105 patients. Patients with AS completed three questionnaires: PD-Q, Beck Depression Inventory (BDI), and Euro Quality of Life (EQ-5D) questionnaires. Patients were classified into three groups according to the PD-Q scores: nociceptive pain (NoP) (score ≤ 12), mixed pain (MP) (score 13-18), and NeP pain (score ≥ 19). Fifteen patients (14.2%) were classified into the NeP group, 22 (21.0%) in the MP group, and 68 (64.8%) in the NoP group. The questionnaires and clinical and radiographic findings were analyzed. Patients with NeP and MP scored worse on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); BDI; modified Stoke Ankylosing Spondylitis Spine Score; pain-visual analog scale (VAS); and EQ-5L index and showed an increased prevalence of enthesitis and peripheral arthritis. There were no differences in objective inflammatory markers. PD-Q scores were positively correlated with pain-VAS, BASDAI, BDI, and inversely correlated with EQ-5D index. Age, BASDAI, presence of current enthesitis, and BDI score were independently associated with PD-Q scores. The findings showed that NeP component in AS was associated with age, high disease activity, presence of current enthesitis, and depression.
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Giudice AL, Brewer I, Leonardi R, Roberts N, Bagnato G. Pain threshold and temporomandibular function in systemic sclerosis: comparison with psoriatic arthritis. Clin Rheumatol 2018; 37:1861-1867. [PMID: 29445986 DOI: 10.1007/s10067-018-4028-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/26/2018] [Accepted: 02/06/2018] [Indexed: 01/20/2023]
Abstract
The aim of the study was to evaluate whether a reduced pain threshold is associated with increased temporomandibular dysfunction in systemic sclerosis (SSc) compared to psoriatic arthritis (PsA) and healthy controls. Ninety subjects participated in the study (30 SSc, 30 PsA, and 30 healthy controls). The Helkimo index was used to evaluate temporomandibular dysfunction. Digital palpation was performed at the temporomandibular joint (TMJ) surface and at the superficial masseter muscle (SMM) and pain intensity was recorded on a visual analog scale (VAS), while pain pressure threshold (PPT) was measured at the same sites through a pressure algometer. PPT scores were lower in SSc patients compared to PsA patients and controls. In addition, the average Helkimo index score, measuring the degree of TMJ dysfunction, was higher in SSc compared to PsA and controls. A significant inverse correlation was observed between every PPT score, and both Helkimo index and VAS palpation in SSc and PsA. Both the range of motion and all the other pain-related subdomains of the Helkimo index score (pain on movement, pain palpation TMJ and pain palpation muscle) were significantly worse in SSc compared to PsA, while no significant differences were observed in the TMJ function subdomain. In SSc patients, the skin score was directly associated with the range of motion subdomain of the Helkimo index. Our results confirm that TMJ function is impaired in SSc; further longitudinal studies are needed to assess the role of pain threshold in the assessment of limitations in TMJ function and to identify an objective marker of therapeutic response.
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Affiliation(s)
- Antonino Lo Giudice
- Department of Medical-Surgical Specialties, Department of Orthodontics, Policlinico Universitario "Vittorio Emanuele", University of Catania, Via Santa Sofia 78, 95123, Catania, Italy. .,Department of Biomedical and Dental Sciences and Morphofunctional Imaging - Section of Orthodontics, School of Dentistry, Policlinico Universitario "G. Martino", University of Messina, Via Consolare Valeria, 98123, Messina, Italy.
| | - Idona Brewer
- Department of Medicine, Division of Rheumatology, University of Louisville School of Medicine, 401 E. Chestnut St. Suite 690, Louisville, KY, 40202, USA
| | - Rosalia Leonardi
- Department of Medical-Surgical Specialties, Department of Orthodontics, Policlinico Universitario "Vittorio Emanuele", University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Neal Roberts
- Department of Medicine, Division of Rheumatology, University of Louisville School of Medicine, 401 E. Chestnut St. Suite 690, Louisville, KY, 40202, USA
| | - Gianluca Bagnato
- Division of Rheumatology, Department of Clinical and Experimental Medicine, Policlinico Universitario "G. Martino", University of Messina, Via Consolare Valeria, 98125, Messina, Italy
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20
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Zhou B, Li G, Zhang Y, Zhao Z. Effects of Nursing Interventions on Depression of Patients With Rheumatoid Arthritis: A Meta-Analysis of Randomized Controlled Trials. Arch Psychiatr Nurs 2016; 30:717-721. [PMID: 27888965 DOI: 10.1016/j.apnu.2016.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/12/2016] [Accepted: 06/18/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Previous randomized controlled trials have led to conflicting findings regarding the effects of nursing interventions on depression of patients with rheumatoid arthritis (RA). The purpose of this study was to use the meta-analytic approach to resolve these discrepancies. METHODS We performed a systematic search of publications using MEDLINE, EMBASE, the Cochrane Library, and manual searches without language restrictions. Studies that met the following criteria were included: (1) randomized controlled trials; (2) duration of intervention≥4 weeks; (3) comparative control group; (4) adults with RA; (5) published studies in any language since reception; and (6) psychological symptoms assessed. We extracted relative risks (RRs) and 95% confidence internals (CIs) and pooled them using a random effect model. We carried out sensitivity analysis and assessed heterogeneity and publication bias. RESULTS A total of 14 studies, including 1803 patients, were eligible for inclusion in the review. Depression symptom was assessed by questionnaires. In the pooled analysis, nursing interventions, including exercise training, medication guide, health education and psychotherapy were associated with the remission of depression (RR: -0.67; 95% CI: -0.89 to -0.46; P<0.01) with significant heterogeneity between studies (P<0.01). CONCLUSION Nursing interventions may be important adjunctive therapies in the medical management of RA patients.
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Affiliation(s)
- Biyun Zhou
- Medical School of Southeast University, Nanjing, Jiangsu, China.
| | - Guohong Li
- Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
| | - Yuqun Zhang
- Medical School of Southeast University, Nanjing, Jiangsu, China
| | - Zihan Zhao
- Medical School of Southeast University, Nanjing, Jiangsu, China
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21
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Højgaard P, Christensen R, Dreyer L, Mease P, de Wit M, Skov L, Glintborg B, Christensen AW, Ballegaard C, Bliddal H, Bukhave K, Bartels EM, Amris K, Ellegaard K, Kristensen LE. Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis: protocol for a prospective, exploratory cohort study. BMJ Open 2016; 6:e010650. [PMID: 27084281 PMCID: PMC4838702 DOI: 10.1136/bmjopen-2015-010650] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Persistent pain is a major concern for patients with psoriatic arthritis (PsA). Pain may be due to inflammatory activity or augmented central pain processing. Unawareness of the origin and mechanisms of pain can lead to misinterpretation of disease activity (by composite scores) and erroneous treatments. Ultrasonography (US) is a highly sensitive method to detect tissue inflammation. Evaluating pain mechanisms in relation to US measures may prove valuable in predicting response to treatment in PsA. AIMS To study the association and prognostic value of pain mechanisms, ultrasonic activity and clinical outcomes in patients with PsA who intensify antirheumatic treatment. METHODS AND ANALYSES 100 participants >18 years of age with PsA who initiate or switch antirheumatic treatment (biologicals and/or conventional synthetic disease-modifying antirheumatic drugs (DMARDs)) will be prospectively recruited from outpatient clinics in Copenhagen. All data (demographics, clinical, imaging, blood samples and patient-reported outcomes) will be collected at baseline and after 4 months. Pain is assessed by the PainDETECT Questionnaire, Visual Analogue Scale for pain, Swollen to Tender Joint Count Ratio, Widespread Pain Index and tender point examination. The association between pain variables and clinical/US characteristics will be described by correlation analyses. The predictive value of pain measures and baseline US scores on treatment response will be analysed with regression models. Outcomes are composite and clinical, as well as patient reported. ETHICS AND DISSEMINATION The study is approved by the ethics committee of the Capital Region of Denmark (H-15009080) and has been designed in cooperation with patient research partners. The study is registered at clinicaltrials.gov (number NCT02572700). Results will be disseminated through publication in international peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02572700, Pre-results.
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Affiliation(s)
- Pil Højgaard
- Bispebjerg and Frederiksberg Hospital, The Parker Institute, Frederiksberg, Denmark
- Department of Rheumatology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Robin Christensen
- Bispebjerg and Frederiksberg Hospital, The Parker Institute, Frederiksberg, Denmark
| | - Lene Dreyer
- Bispebjerg and Frederiksberg Hospital, The Parker Institute, Frederiksberg, Denmark
- Department of Rheumatology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Philip Mease
- Swedish Medical Center, University of Washington, Seattle, Washington, USA
| | - Maarten de Wit
- Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands
| | - Lone Skov
- Department of Dermato-Allergology, Herlev and Gentofte Hospital, Hellerup, Denmark
- Faculty of health and medical sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bente Glintborg
- Department of Rheumatology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | | | - Christine Ballegaard
- Bispebjerg and Frederiksberg Hospital, The Parker Institute, Frederiksberg, Denmark
| | - Henning Bliddal
- Bispebjerg and Frederiksberg Hospital, The Parker Institute, Frederiksberg, Denmark
- Faculty of health and medical sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Bukhave
- Department of Dermato-Allergology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Else Marie Bartels
- Bispebjerg and Frederiksberg Hospital, The Parker Institute, Frederiksberg, Denmark
| | - Kirstine Amris
- Bispebjerg and Frederiksberg Hospital, The Parker Institute, Frederiksberg, Denmark
| | - Karen Ellegaard
- Bispebjerg and Frederiksberg Hospital, The Parker Institute, Frederiksberg, Denmark
| | - Lars Erik Kristensen
- Bispebjerg and Frederiksberg Hospital, The Parker Institute, Frederiksberg, Denmark
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Bagnato GL, Miceli G, Marino N, Sciortino D, Bagnato GF. Pulsed electromagnetic fields in knee osteoarthritis: a double blind, placebo-controlled, randomized clinical trial. Rheumatology (Oxford) 2015; 55:755-62. [PMID: 26705327 PMCID: PMC4795538 DOI: 10.1093/rheumatology/kev426] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This trial aimed to test the effectiveness of a wearable pulsed electromagnetic fields (PEMF) device in the management of pain in knee OA patients. METHODS In this randomized [with equal randomization (1:1)], double-blind, placebo-controlled clinical trial, patients with radiographic evidence of knee OA and persistent pain higher than 40 mm on the visual analog scale (VAS) were recruited. The trial consisted of 12 h daily treatment for 1 month in 60 knee OA patients. The primary outcome measure was the reduction in pain intensity, assessed through VAS and WOMAC scores. Secondary outcomes included quality of life assessment through the 36-item Medical Outcomes Study Short-Form version 2 (SF-36 v2), pressure pain threshold (PPT) and changes in intake of NSAIDs/analgesics. RESULTS Sixty-six patients were included, and 60 completed the study. After 1 month, PEMF induced a significant reduction in VAS pain and WOMAC scores compared with placebo. Additionally, pain tolerance, as expressed by PPT changes, and physical health improved in PEMF-treated patients. A mean treatment effect of -0.73 (95% CI - 1.24 to - 0.19) was seen in VAS score, while the effect size was -0.34 (95% CI - 0.85 to 0.17) for WOMAC score. Twenty-six per cent of patients in the PEMF group stopped NSAID/analgesic therapy. No adverse events were detected. CONCLUSION These results suggest that PEMF therapy is effective for pain management in knee OA patients and also affects pain threshold and physical functioning. Future larger studies, including head-to-head studies comparing PEMF therapy with standard pharmacological approaches in OA, are warranted. TRIAL REGISTRATION ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT01877278.
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Affiliation(s)
- Gian Luca Bagnato
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Giovanni Miceli
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Natale Marino
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Davide Sciortino
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Gian Filippo Bagnato
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Messina, Italy
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Sanches ML, Juliano Y, Novo NF, Guimarães AS, Rodrigues Conti PC, Alonso LG. Correlation between pressure pain threshold and pain intensity in patients with temporomandibular disorders who are compliant or non-compliant with conservative treatment. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:459-68. [DOI: 10.1016/j.oooo.2015.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/13/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
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Abstract
Epidemiologic studies have shown that, in patients with psoriatic arthritis (PsA), associated comorbidities may occur more frequently than expected. This article discusses related comorbidities in patients with PsA. Identifying these comorbidities may affect the management and treatment decisions for these patients to ensure an optimal clinical outcome. All health care providers caring for patients with PsA should be aware of the relevant comorbidities and should have an understanding of how these comorbidities affect management. The common comorbidities include cardiovascular disease, metabolic syndrome, obesity, diabetes, fatty liver disease, inflammatory bowel disease, ophthalmic disease, kidney disease, osteoporosis, depression, and anxiety.
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Henriksen M, Klokker L, Graven-Nielsen T, Bartholdy C, Schjødt Jørgensen T, Bandak E, Danneskiold-Samsøe B, Christensen R, Bliddal H. Association of exercise therapy and reduction of pain sensitivity in patients with knee osteoarthritis: a randomized controlled trial. Arthritis Care Res (Hoboken) 2015; 66:1836-43. [PMID: 24905427 DOI: 10.1002/acr.22375] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 05/27/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Exercise has beneficial effects on pain in knee osteoarthritis (OA), yet the underlying mechanisms are unclear. The purpose of this study was to investigate the effects of exercise on pressure-pain sensitivity in patients with knee OA. METHODS In a randomized controlled trial, participants were assigned to 12 weeks of supervised exercise therapy (ET; 36 sessions) or a no attention control group (CG). Pressure-pain sensitivity was assessed by cuff pressure algometry on the calf of the most symptomatic leg. The coprimary outcomes were pressure-pain thresholds (PPTs) and cumulated visual analog scale pain scores during constant pressure for 6 minutes at 125% of the PPT as a measure of temporal summation (TS) of pressure-pain. Secondary outcomes included self-reported pain using the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Analyses were based on the "per-protocol" population (participants following the protocol). RESULTS Sixty participants were randomized (31 in ET group, 29 in CG), and the per-protocol population included 48 participants (25 in ET group, 23 in CG). At followup, mean group differences in the change from baseline were 3.1 kPa (95% confidence interval [95% CI] 0.2, 6.0; P = 0.038) for the PPT, 2,608 mm × seconds (95% CI 458, 4,758; P = 0.019) for TS, and 6.8 points (95% CI 1.2, 12.4; P = 0.018) for KOOS pain, all in favor of ET. CONCLUSION Pressure-pain sensitivity, TS, and self-reported pain are reduced among patients completing a 12-week supervised exercise program compared to a no attention CG. These results demonstrate beneficial effects of exercise on basic pain mechanisms and further exploration may provide a basis for optimized treatment.
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Affiliation(s)
- Marius Henriksen
- Copenhagen University Hospitals Bispebjerg and Frederiksberg, Copenhagen, Denmark
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