1
|
Selmi C, Chimenti MS, Novelli L, Parikh BK, Morello F, de Vlam K, Ciccia F. Pain in axial spondyloarthritis: role of the JAK/STAT pathway. Front Immunol 2024; 15:1341981. [PMID: 38464510 PMCID: PMC10921361 DOI: 10.3389/fimmu.2024.1341981] [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: 11/21/2023] [Accepted: 02/05/2024] [Indexed: 03/12/2024] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that is characterized by new bone formation in the axial musculoskeletal system, with X-ray discriminating between radiographic and non-radiographic forms. Current therapeutic options include non-steroidal anti-inflammatory drugs in addition to biological disease-modifying anti-rheumatic drugs that specifically target tumor necrosis factor-alpha (TNFα) or interleukin (IL)-17. Pain is the most critical symptom for axSpA patients, significantly contributing to the burden of disease and impacting daily life. While the inflammatory process exerts a major role in determining pain in the early phases of the disease, the symptom may also result from mechanical and neuromuscular causes that require complex, multi-faceted pharmacologic and non-pharmacologic treatment, especially in the later phases. In clinical practice, pain often persists and does not respond further despite the absence of inflammatory disease activity. Cytokines involved in axSpA pathogenesis interact directly/indirectly with the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signaling cascade, a fundamental component in the origin and development of spondyloarthropathies. The JAK/STAT pathway also plays an important role in nociception, and new-generation JAK inhibitors have demonstrated rapid pain relief. We provide a comprehensive review of the different pain types observed in axSpA and the potential role of JAK/STAT signaling in this context, with specific focus on data from preclinical studies and data from clinical trials with JAK inhibitors.
Collapse
Affiliation(s)
- Carlo Selmi
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | | | - Bhumik K. Parikh
- Global Medical Affairs, AbbVie, Inc., Mettawa, IL, United States
| | | | - Kurt de Vlam
- Department of Rheumatology, University Hospital Leuven, Leuven, Belgium
- Skeletal Biology and Engineering Research Center (SBE), Department of Development and Regeneration, KULeuven, Leuven, Belgium
| | - Francesco Ciccia
- Department of Precision Medicine Napoli, Università degli Studi della Campania “Luigi Vanvitelli”, Caserta, Italy
| |
Collapse
|
2
|
Al Mohamad F, Rios Rodriguez V, Haibel H, Protopopov M, Rademacher J, Sieper J, Torgutalp M, Käding H, Proft F, Poddubnyy D. Association of nociplastic and neuropathic pain components with the presence of residual symptoms in patients with axial spondyloarthritis receiving biological disease-modifying antirheumatic drugs. RMD Open 2024; 10:e004009. [PMID: 38360039 PMCID: PMC10875534 DOI: 10.1136/rmdopen-2023-004009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To evaluate the association of nociplastic (NoP) and neuropathic pain (NP) components with residual symptoms in patients with radiographic axial spondyloarthritis (r-axSpA) receiving biological disease-modifying antirheumatic drugs (bDMARDs). METHODS 78 patients with r-axSpA from the GErman SPondyloarthritis Inception Cohort receiving a bDMARD for at least 3 months were included in this analysis. The Widespread Pain Index (WPI) and the PainDETECT (PD) questionnaire were used to quantify the NoP and the NP components, respectively. Axial Spondyloarthritis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were used as measures of residual symptoms. C reactive protein (CRP) was used as a measure of systemic inflammatory activity. Univariable and multivariable regression analyses of disease activity were performed. The regions of the WPI score and items of the PD score were used for cluster analyses. RESULTS Linear multivariable regression analysis showed that WPI and PD were independently associated with ASDAS (b=0.1, 95% CI 0.04 to 0.17, and b=0.05, 95% CI 0.02 to 0.08, respectively) and BASDAI (b=0.24, 95% CI 0.08 to 0.39, and b=0.17, 95% CI 0.1 to 0.25, respectively) in r-axSpA patients receiving stable treatment with bDMARDs. Furthermore, WPI and PD were found to be significantly associated with the presence of relevant residual symptoms as defined by BASDAI ≥4 (OR 1.93, 95% CI 1.09 to 4.15, and OR 1.32, 95% CI 1.04 to 1.85, respectively). The effects were present also in patients with normal level of CRP. Cluster analysis revealed three distinct pain distribution profiles and four specific sensory symptom constellations allowing differentiation of different pain subtypes. CONCLUSION Both NoP and NP components seem to be associated with residual symptoms in patients with r-axSpA receiving treatment with bDMARDs.
Collapse
Affiliation(s)
- Fares Al Mohamad
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Murat Torgutalp
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Henriette Käding
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Epidemiology Unit, German Rheumatism Research Centre Berlin, Berlin, Germany
| |
Collapse
|
4
|
Poddubnyy D, Pournara E, Zielińska A, Baranauskaite A, Jiménez AM, Sadhu S, Schulz B, Rissler M, Perella C, Marzo-Ortega H. Rapid improvement in spinal pain in patients with axial spondyloarthritis treated with secukinumab: primary results from a randomized controlled phase-IIIb trial. Ther Adv Musculoskelet Dis 2021; 13:1759720X211051471. [PMID: 34707696 PMCID: PMC8544765 DOI: 10.1177/1759720x211051471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/20/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy and safety of secukinumab 150 mg compared with placebo in the management of spinal pain and disease activity in patients with axial spondyloarthritis (axSpA) at Week 8 and up to Week 24. METHODS Patients (n = 380) with active axSpA were randomized (3:1) to secukinumab 150 mg (Group A) or placebo (Group B). At Week 8, patients from Group A with an average spinal pain score <4 were defined as responders and were re-assigned to secukinumab 150 mg (Arm A1); whereas non-responders were re-randomized to secukinumab 150/300 mg (Arm A2/A3). Patients from Group B were re-randomized (1:1) to secukinumab 150/300 mg (Arm B1/B2). RESULTS At Week 8, the odds of achieving an average spinal pain score of <4 were significantly higher for patients on secukinumab 150 mg than for patients on placebo (odds ratio (OR): 1.89; 95% confidence interval (CI): 1.08-3.33; p = 0.0264). Further reductions in spinal pain were observed across treatment groups up to Week 24. Pronounced improvements were also observed in other disease activity measurements, such as Bath Ankylosing Spondylitis Disease Activity Index and Ankylosing Spondylitis Disease Activity Score. Responders from Group A showed the highest improvements for all measured parameters of spinal pain compared with the other arms. No new or unexpected safety signals were observed. CONCLUSION Secukinumab provided rapid and significant improvement in spinal pain at Week 8 which was sustained or increased further up to Week 24 in patients with axSpA. TRIAL REGISTRATION ClinicalTrials.gov: NCT03136861. Registered May 2, 2017.
Collapse
Affiliation(s)
- Denis Poddubnyy
- Head of the Rheumatology Unit, Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
- Department of Epidemiology, German Rheumatism Research Centre, Berlin, Germany
| | | | | | | | | | | | | | | | | | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, LTHT and LIRMM, University of Leeds, Leeds, UK
| |
Collapse
|
5
|
Shraim MA, Massé-Alarie H, Hodges PW. Methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a systematic review. Pain 2021; 162:1007-1037. [PMID: 33136983 DOI: 10.1097/j.pain.0000000000002113] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022]
Abstract
ABSTRACT Mechanism-based classification of pain has been advocated widely to aid tailoring of interventions for individuals experiencing persistent musculoskeletal pain. Three pain mechanism categories (PMCs) are defined by the International Association for the Study of Pain: nociceptive, neuropathic, and nociplastic pain. Discrimination between them remains challenging. This study aimed to build on a framework developed to converge the diverse literature of PMCs to systematically review methods purported to discriminate between them; synthesise and thematically analyse these methods to identify the convergence and divergence of opinion; and report validation, psychometric properties, and strengths/weaknesses of these methods. The search strategy identified articles discussing methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system. Studies that assessed the validity of methods to discriminate between categories were assessed for quality. Extraction and thematic analysis were undertaken on 184 articles. Data synthesis identified 200 methods in 5 themes: clinical examination, quantitative sensory testing, imaging, diagnostic and laboratory testing, and pain-type questionnaires. Few methods have been validated for discrimination between PMCs. There was general convergence but some disagreement regarding findings that discriminate between PMCs. A combination of features and methods, rather than a single method, was generally recommended to discriminate between PMCs. Two major limitations were identified: an overlap of findings of methods between categories due to mixed presentations and many methods considered discrimination between 2 PMCs but not others. The results of this review provide a foundation to refine methods to differentiate mechanisms for musculoskeletal pain.
Collapse
Affiliation(s)
- Muath A Shraim
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD, Australia
| | - Hugo Massé-Alarie
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD, Australia
- Centre Interdisciplinaire de recherche en réadaptation et Integration sociale (CIRRIS), Université Laval, Québec, QC, Canada
| | - Paul W Hodges
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD, Australia
| |
Collapse
|
6
|
Deng S, He Y, Deng S, Sun E, Li L. Association between clinical characteristics and pain relief in patients with axial spondyloarthritis treated with non-steroidal anti-inflammatory drugs. Arch Rheumatol 2020; 37:271-279. [PMID: 36017198 PMCID: PMC9377172 DOI: 10.46497/archrheumatol.2022.8485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/30/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives
The aim of this study was to evaluate pain relief in axial spondyloarthritis (axSpA) patients treated with non-steroidal anti-inflammatory drugs (NSAIDs) and to investigate the relation of the demographic, clinical, and psychological characteristics with pain relief. Patients and methods
Between February 2017 and December 2019, a total of 94 patients (61 males, 33 females; mean age: 28.3±8.1 years; range, 14 to 54 years) who were diagnosed with axSpA and treated with NSAIDs were included. The patients were assessed at baseline and at three months. A reduction of 30% in the Numeric Rating Scale (NRS) indicates a clinically meaningful improvement. The patients were divided into the relief group (≥30% improvement in NRS) and non-relief group (<30% improvement). Potential influential factors for pain relief such as neuropathic pain (NP), disease activity, function, pain catastrophizing, and pain self-efficacy were assessed. The relationship between patients’ characteristics and pain relief was analyzed. Results
Seventy-two (76.6%) patients achieved pain relief. These patients had significantly higher baseline erythrocyte sedimentation rate, C-reactive protein, and lower percentage of NP. There was no significant difference between the two groups in function, pain catastrophizing, and pain self-efficacy. Multiple logistic regression analysis revealed that patients with NP were less likely to achieve pain relief (odds ratio [OR]: 3.531, 95% confidence interval [CI]: 1.155-10.789; p=0.027). Conclusion
Pain relief is still insufficient in some axSpA patients, despite the administration of NSAIDs. The presence of NP is significantly associated with poor pain relief. Alternative medications instead of NSAIDs are needed to achieve optimal pain relief, when NP is diagnosed.
Collapse
Affiliation(s)
- Shiyi Deng
- Department of Nursing, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yi He
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Sisi Deng
- Department of Nursing, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Erwei Sun
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Li Li
- Department of Nursing, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
8
|
Di Carlo M, Muto P, Benfaremo D, Luchetti MM, Atzeni F, Salaffi F. The Neuropathic Pain Features in Psoriatic Arthritis: A Cross-sectional Evaluation of Prevalence and Associated Factors. J Rheumatol 2019; 47:1198-1203. [PMID: 31787602 DOI: 10.3899/jrheum.190906] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the prevalence and factors associated with the neuropathic pain features in a cohort of patients with psoriatic arthritis (PsA). METHODS A cross-sectional evaluation was conducted in consecutive patients having PsA with prevalent peripheral joint involvement, referred to 3 rheumatological centers. For each patient, a comprehensive assessment of disease activity, physical function, and disease effect was carried out. The presence of comorbid fibromyalgia syndrome (FMS) was evaluated. Acute-phase reactants were also recorded. The neuropathic pain features were investigated through the PainDETECT Questionnaire (PDQ). A logistic regression analysis was therefore conducted using the PDQ as the dependent variable. RESULTS The final evaluation included 118 patients. A comorbid FMS was detectable in 30 of the 118 patients with PsA (25.4%). Probable characteristics of neuropathic pain (PDQ ≥ 19) were found in 30 (25.4%) patients overall, ambiguous (PDQ > 12 and < 19) in 21 (17.8%) patients, and unlikely (PDQ ≤ 12) in 67 (56.8%) patients. Using logistic regression analysis, the only independent variable among those investigated that could explain the neuropathic pain features was the presence of a comorbid FMS (p = 0.0127). Excluding patients with comorbid FMS, an association with disability (measured by Health Assessment Questionnaire-Disability Index) emerges (p = 0.0489). In patients with PsA and comorbid FMS, PDQ scores were significantly higher than in patients without comorbid FMS. CONCLUSION Neuropathic pain features are common in patients with PsA, and the presence of pain sensitization (comorbid FMS) seems to be its main predictor.
Collapse
Affiliation(s)
- Marco Di Carlo
- From the Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani," Jesi (Ancona); Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina, Messina; Medical Clinic, Università Politecnica delle Marche, Ancona, Italy. .,M. Di Carlo, MD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani"; P. Muto, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; D. Benfaremo, MD, Medical Clinic, Università Politecnica delle Marche; M.M. Luchetti, MD, Medical Clinic, Università Politecnica delle Marche; F. Atzeni, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; F. Salaffi, MD, PhD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani."
| | - Pietro Muto
- From the Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani," Jesi (Ancona); Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina, Messina; Medical Clinic, Università Politecnica delle Marche, Ancona, Italy.,M. Di Carlo, MD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani"; P. Muto, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; D. Benfaremo, MD, Medical Clinic, Università Politecnica delle Marche; M.M. Luchetti, MD, Medical Clinic, Università Politecnica delle Marche; F. Atzeni, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; F. Salaffi, MD, PhD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani."
| | - Devis Benfaremo
- From the Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani," Jesi (Ancona); Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina, Messina; Medical Clinic, Università Politecnica delle Marche, Ancona, Italy.,M. Di Carlo, MD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani"; P. Muto, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; D. Benfaremo, MD, Medical Clinic, Università Politecnica delle Marche; M.M. Luchetti, MD, Medical Clinic, Università Politecnica delle Marche; F. Atzeni, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; F. Salaffi, MD, PhD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani."
| | - Michele Maria Luchetti
- From the Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani," Jesi (Ancona); Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina, Messina; Medical Clinic, Università Politecnica delle Marche, Ancona, Italy.,M. Di Carlo, MD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani"; P. Muto, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; D. Benfaremo, MD, Medical Clinic, Università Politecnica delle Marche; M.M. Luchetti, MD, Medical Clinic, Università Politecnica delle Marche; F. Atzeni, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; F. Salaffi, MD, PhD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani."
| | - Fabiola Atzeni
- From the Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani," Jesi (Ancona); Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina, Messina; Medical Clinic, Università Politecnica delle Marche, Ancona, Italy.,M. Di Carlo, MD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani"; P. Muto, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; D. Benfaremo, MD, Medical Clinic, Università Politecnica delle Marche; M.M. Luchetti, MD, Medical Clinic, Università Politecnica delle Marche; F. Atzeni, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; F. Salaffi, MD, PhD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani."
| | - Fausto Salaffi
- From the Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani," Jesi (Ancona); Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina, Messina; Medical Clinic, Università Politecnica delle Marche, Ancona, Italy.,M. Di Carlo, MD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani"; P. Muto, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; D. Benfaremo, MD, Medical Clinic, Università Politecnica delle Marche; M.M. Luchetti, MD, Medical Clinic, Università Politecnica delle Marche; F. Atzeni, MD, Rheumatology Unit, Policlinico Universitario "G. Martino," Università degli studi di Messina; F. Salaffi, MD, PhD, Rheumatological Clinic, Università Politecnica delle Marche, Ospedale "C. Urbani."
| |
Collapse
|