Prevalence of Neuropathic Pain in Rheumatic Disorders: Association With Disease Activity, Functional Status and Quality of Life

Abstract

Objectives: This study aims to investigate neuropathic pain in rheumatologic disorders including rheumatoid arthritis (RA), ankylosing spondylitis (AS), and osteoarthritis (OA) using PainDETECT and to determine its effect on the quality of life in terms of disease activity, functional status, social and emotional functioning. Patients and methods: A total of 150 patients (66 males, 84 females; mean age 48.44±12.22 years; range 25 to 65 years) were included in the study. Of these patients, 50 had OA, 50 had RA, and 50 had AS. Control group consisted of 50 healthy subjects (20 males, 30 females; mean age 48.36±12.68 years; range 25 to 65 years). OA severity was evaluated by Western Ontario and McMasters Universities Index of Osteoarthritis. In RA patients, Disease Activity Score-28 was used for measuring disease activity, and Stanford Health Assessment Questionnaire for functional status. In AS patients, disease activity was assessed by Bath Ankylosing Spondylitis Disease Activity Index and functional status by Bath Ankylosing Spondylitis Functional Index. Neuropathic pain was determined by PainDETECT questionnaire and quality of life by Nottingham Health Profile. Results: Prevalence of neuropathic pain was 44% in OA, 28% in AS, and 18% in RA patients. Compared with control patients, prevalence was higher in OA [Odds ratio=12.46 95% confidence interval (3.89-39.85)] (p=0.00) and AS patients [Odds ratio=4.47 95% confidence interval (1.36-14.76)] (p=0.009). In OA patients, PainDETECT was correlated with Western Ontario and McMasters Universities Index of Osteoarthritis (p=0.00). In all of the patient groups, PainDETECT was correlated with Nottingham Health Profile (p=0.00). Physical mobility subgroup showed the strongest correlation with PainDETECT. Conclusion: Our study demonstrated that neuropathic pain is strongly associated with quality of life in terms of physical mobility, energy, sleep, and social and emotional functions. The disease with highest prevalence of neuropathic pain was OA. A better understanding of neuropathic pain mechanisms in rheumatic diseases will help us find more effective treatment strategies.

Association of neuropathic pain with ultrasonographic measurements of femoral cartilage thickness and clinical parameters in patients with knee osteoarthritis

“…Hyperalgesia and poor quality of life were shown to be associated in patients with knee osteoarthritis6 ) . There are other studies that have reported an association between higher painDETECT scores and decreased quality of life in patients with osteoarthritis22 ) . The presence and severity of neuropathic pain are known to have an adverse effect on the quality of life in several conditions aside from rheumatic diseases23 ) .…”

Quality of life and functional capacity are adversely affected in osteoarthritis patients with neuropathic pain

“…The presence and severity of neuropathic pain is known to cause mood disorders and impaired quality of life in rheumatic diseases in general [33]. High PainDETECT scores in patients with OA have been shown to be associated with impaired quality of life [34]; whereas Hochman et al [30] noted a significant association between depression and neuropathic pain in patients with knee OA. In addition, in patients with neuropathic pain as determined with PainDETECT scale, Mesci et al [35] found higher WOMAC and HAD anxiety–depression scores and lower scores from the SF‐36.…”

e association of neuropathic pain and disease activity, functional level, and quality of life in patients with ankylosing spondylitis: a cross-sectional study

“…Inflammatory radiculopathy without any mechanic compression advanced by local inflammation of the axial spine in AS may be another peripheral mechanism (31). Dysregulation of central pain processing mechanisms and central sensitization is the underlying pathology of NP.…”