Neuropathic‐like pain symptoms in inflammatory hand osteoarthritis lower quality of life and may not decrease under prednisolone treatment

Abstract

Background: Pain is common in hand osteoarthritis (OA) and multiple types may occur. We investigated the prevalence, associated patient characteristics, influence on health-related quality of life (HR-QoL) and response to antiinflammatory treatment of neuropathic-like pain in inflammatory hand OA. Methods: Data were analysed from a 6-week, randomized, double-blind, placebocontrolled trial investigating prednisolone treatment in 92 patients with painful inflammatory hand OA. Neuropathic-like pain was measured with the painDE-TECT questionnaire. Associations between baseline characteristics and baseline neuropathic-like pain were analysed with ordinal logistic regression, association of baseline neuropathic-like pain symptoms with baseline HR-QoL with linear regression, painDETECT and visual analogue scale (VAS) change from baseline to week 6 and interaction of painDETECT with prednisolone efficacy on VAS pain change from baseline to week 6 with generalized estimating equations (GEE).Results: Of 91 patients (79% female, mean age 64) with complete painDETECT data at baseline, 53% were unlikely to have neuropathic-like pain, 31% were indeterminate and 16% were likely to have neuropathic-like pain. Neuropathic-like pain was associated with female sex, less radiographic damage and more comorbidities. Patients with neuropathic-like pain had lower HR-QoL (PCS-6.5 [95% CI −10.4 to −2.6]) than those without. Neuropathic-like pain symptoms remained under prednisolone treatment and no interaction was seen between painDETECT and prednisolone efficacy on VAS pain. Conclusions:In this study, 16% of inflammatory hand OA patients had neuropathiclike pain. They were more often female, had more comorbidities and had lower QoLThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Assessment of Neuropathic Pain in Erosive Hand Osteoarthritis

“…A previous study used the DN4 questionnaire and found that 42% of patients with hand OA experienced NP [9], in line with our own findings using the same questionnaire. Another study previously used the PainDETECT questionnaire and reported an NP frequency of 19% in patients with hand OA [10], which is lower than that observed in our study (32.4%) using this questionnaire. Petterson et al found a prevalence of 42% for central sensitization measured with temporal summation tests in patients with hand OA [27].…”

“…In subjects affected by knee OA, NP correlates with the severity of symptoms, joint function, psychological well-being, and the intake of painkillers [ 7 , 8 ]. Although understudied, it has been reported that NP may occur in 16–42% of patients with hand OA using different assessment questionnaires [ 9 , 10 ]. In the Magni N et al cohort of 121 patients with symptomatic hand OA, the prevalence of NP was estimated at 42% using the Douleur Neuropathique en 4 Questions (DN4) questionnaire [ 9 ].…”

“…In the Magni N et al cohort of 121 patients with symptomatic hand OA, the prevalence of NP was estimated at 42% using the Douleur Neuropathique en 4 Questions (DN4) questionnaire [ 9 ]. Conversely, in a study comprising 91 patients using the PainDETECT instrument, 16% were deemed likely to have NP, 53% undetermined, and 31% not likely [ 10 ]. In this study, 73% of patients had EHOA, defined as having at least one proximal (PIP) or distal interphalangeal joint (DIP) in the erosive or remodeling phase according to the Verbruggen–Veys score [ 10 ].…”

Patterns and natural history of hand pain in individuals with symptomatic hand osteoarthritis in a prospective cohort study: A post-hoc analysis of a randomised controlled trial

“…This may in part be explained by the greater number of joints involved, the longer duration of the disease, and presence of higher neuropathic-like pain in those with both the CMC and IP pain. The potential effect of neuropathic-like pain is supported by our findings of a lower prevalence of moderate to severe radiological (KL grade 3–4) and higher neuropathic-like pain in participants with both the and IP pain, which is similar to previous findings [ 10 , 23 ].…”

“…Additionally, our results suggest that neuropathic-like pain may be especially important in those with pain at more than one site, irrespective of the degree of joint damage which is supported by previous data [ 24 , 25 ]. The presence of neuropathic-like pain may reduce the efficacy of other therapies in OA [ 23 ]. This needs to be considered when developing treatment strategies for patients and consideration should be given to target neuropathic-like pain when present.…”