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KAYACAN ERDOĞAN E, TÜRK İ. Nöropatik ağrı aksiyal spondiloartritte gözden kaçan bir semptom mu? CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1096777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Amaç: Aksiyal spondiloartitler (axSpA) kronik inflamatuar romatolojik hastalıklardan olup ağrı yaşam kalitelerini etkileyen en sık semptomdur. Literatürde ağrının her zaman inflamasyonla korele olmadığı gösterilmiştir. Bu çalışma ile aksiyal spondiloartrit hastalarında nöropatik ağrının frekansının gösterilmesi ve nöropatik ağrı ile hasta özelliklerinin arasındaki ilişkinin gösterilmesi amaçlanmıştır.
Gereç ve Yöntem: Kliniğimizde Ocak- Mart 2019 ayları arasında takip edilen, Assessment of SpondyloArthritis International Society klasifikasyon kriterlerine göre axSpA kabul edilen hastalar çalışmaya dahil edilmiştir. Nöropatik ağrı Douleur Neuropathique en 4 Questions (DN4) ölçeği ile değerlendirildi.
Bulgular: Seksen yedi axSpa hastası çalışmaya dahil edildi. Hastaların 30’unda DN4 ölçeğine göre (DN4 >4) nöropatik ağrı var kabul edildi. Nöropatik ağrı aktif hasta grubunda (ASDAS- CRP ve BASDAI’ ye göre) daha fazla saptandı. DN4 skoru ASDAS- CRP ve BASDAI skoru ile orta düzeyde korele saptandı. Hasta eğitim düzeyi ile DN4 skoru arasında hafif düzeyde korelasyon saptandı.
Sonuç: Çalışmamızda axSpA hastalarında inflamatuvar ağrıya ek olarak nöropatik ağrının görülebileceği ve hastalık aktivitesi ile korele olabileceği gösterildi. Nöropatik ağrı hastaların yaşam kalitesini bozduğu, sosyal ve emosyonel bozukluklara yol açtığı literatürde gösterilmiştir. Hastalar standart anti inflamatuvar tedavi yaklaşımlarından fayda görmeyebilir. AxSpA hastalarında nöropatik ağrının değerlendirilmesi önem kazanmaktadır. AxSpA hastalarında nöropatik ağrının tanı ve tedavi sürecinde ileri çalışmalara gereksinim duyulmaktadır.
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Affiliation(s)
- Esra KAYACAN ERDOĞAN
- ÇUKUROVA ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, İÇ HASTALIKLARI ANABİLİM DALI, ROMATOLOJİ BİLİM DALI
| | - İpek TÜRK
- ÇUKUROVA ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, İÇ HASTALIKLARI ANABİLİM DALI, ROMATOLOJİ BİLİM DALI
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Zhou L, Li T, Wu X, Lu H, Lin L, Ye L, Yin J, Zhao J, Wang X, Bian J, Xu H. Assessment of Neuropathic Pain in Ankylosing Spondylitis: Prevalence and Characteristics. Pain Ther 2021; 10:1467-1479. [PMID: 34482533 PMCID: PMC8586434 DOI: 10.1007/s40122-021-00310-8] [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: 06/30/2021] [Accepted: 08/13/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Pain in ankylosing spondylitis is currently considered an inflammatory pain (IP). However, it was found that some patients still had the sensation of pain even without inflammation. Our study was to investigate the prevalence and characteristics of neuropathic pain (NeP) in Chinese Han ankylosing spondylitis (AS) patients. METHODS The study consisted of three parts. Firstly, we assessed the prevalence and clinical data of NeP in 182 AS patients. Secondly, we evaluated pain improvement after etanercept therapy in 63 patients. Finally, serum neurotransmitters were measured for 20 AS patients and ten healthy controls (HC). RESULTS Out of 182 AS patients, our study showed that 14 patients (7.70%) had likely NeP and 55 (30.21%) had uncertain NeP. There were significant differences among the three groups with respect to nocturnal pain (NP), peripheral pain (PP), total back pain (TBP), BASDAI, ASDAS-CRP, HAD-A, HAD-D, and BASDAI-fatigue except fort CRP concentrations. Principal component analysis (PCA) of AS pain revealed that the weight of NeP was greater than PP in the first principal component (0.703 vs. 0.639). Structural equation modeling (SEM) revealed that NeP altered disease activity (β = 0.62, P < 0.001), which influenced psychological status (β = 0.42, P < 0.001). Of 63 patients who used etanercept for 3 months, significant improvement was found in NP, TBP, and PP (all P < 0.0001) but not in PDQ (10.60 ± 6.85 vs. 9.98 ± 6.40, P = 0.0671). Serum norepinephrine concentrations in patients with PDQ > 19 were higher than those in patients with PDQ ≤ 19 and HC. CONCLUSIONS We conclude that NeP contributes to pain in AS patients.
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Affiliation(s)
- Ling Zhou
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Ting Li
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xin Wu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Hongjuan Lu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Li Lin
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Lingying Ye
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Jian Yin
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Juan Zhao
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xiuwen Wang
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Jianye Bian
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Huji Xu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China.
- Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, 100084, China.
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China.
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