Assessment of Neuropathic Pain in Ankylosing Spondylitis: Prevalence and Characteristics

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 BASDAIfatigue 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 (b = 0.62, P \ 0.001), which influenced psychological status (b = 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 B 19 and HC. Conclusions: We conclude that NeP contributes to pain in AS patients.

The Effect of Neuropathic Pain on Sleep Quality in Patients with Axial Spondyloarthritis

“…Wu et al was the first who demonstrated NP in patients with AS using neuroimaging studies in addition to the painDETECT score (4). In previous studies that used painDETECT scores, NP rates were found to be 25%-37.9% in AxSpA patients (18)(19)(20). Compared to these results, our study showed a higher NP rate of 41.7%.…”

“…VAS scores of patients with NP were twice as severe as patients without NP (23). And also higher BASDAI scores were obtained in patients with NP (20,21). In our study, pain intensity and disease activity were increased, and QoL was significantly impaired with NP presence.…”

Nöropatik ağrı aksiyal spondiloartritte gözden kaçan bir semptom mu?

“…Previous studies have demonstrated that the prevelance of neuropathic pain is approximately 7-8% 16 . There were few studies in the literature about neuropathic pain in AS patients and the results vary (8-31% ) 5,[17][18][19] . In our study we found neuropathic pain in 35% of SpA patients.…”

“…Norepinephrine and seratonin are related to pain and have a role on regulating algesic and analgesic process. Neurotransmitters have regulatory effect on local neurocytes 17,24 .…”

Uncovering the Underworld of Axial Spondyloarthritis

“…IL-17 also has a key role in pain modulation in axial-SpA. Indeed, several studies showed that axial-SpA patients experience phenomena of central sensitization and neuropathic pain that may significantly worsen their quality of life [ 178 , 179 , 180 , 181 , 182 , 183 ]. A recent meta-analysis showed that in a group of 1483 AS patients, 41,5% of them had likely neuropathic pain symptoms, thus, showing the relevance of the phenomenon [ 184 ].…”