Joharatnam Nalinie, McWilliams Daniel F, Wilson Deborah, Wheeler Maggie, Pande Ira, Walsh David A
Arthritis UK Pain Centre, Division of ROD, University of Nottingham, Nottingham, UK.
Department Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK.
Arthritis Res Ther. 2015 Jan 20;17(1):11. doi: 10.1186/s13075-015-0525-5.
Pain remains the most important problem for people with rheumatoid arthritis (RA). Active inflammatory disease contributes to pain, but pain due to non-inflammatory mechanisms can confound the assessment of disease activity. We hypothesize that augmented pain processing, fibromyalgic features, poorer mental health, and patient-reported 28-joint disease activity score (DAS28) components are associated in RA.
In total, 50 people with stable, long-standing RA recruited from a rheumatology outpatient clinic were assessed for pain-pressure thresholds (PPTs) at three separate sites (knee, tibia, and sternum), DAS28, fibromyalgia, and mental health status. Multivariable analysis was performed to assess the association between PPT and DAS28 components, DAS28-P (the proportion of DAS28 derived from the patient-reported components of visual analogue score and tender joint count), or fibromyalgia status.
More-sensitive PPTs at sites over or distant from joints were each associated with greater reported pain, higher patient-reported DAS28 components, and poorer mental health. A high proportion of participants (48%) satisfied classification criteria for fibromyalgia, and fibromyalgia classification or characteristics were each associated with more sensitive PPTs, higher patient-reported DAS28 components, and poorer mental health.
Widespread sensitivity to pressure-induced pain, a high prevalence of fibromyalgic features, higher patient-reported DAS28 components, and poorer mental health are all linked in established RA. The increased sensitivity at nonjoint sites (sternum and anterior tibia), as well as over joints, indicates that central mechanisms may contribute to pain sensitivity in RA. The contribution of patient-reported components to high DAS28 should inform decisions on disease-modifying or pain-management approaches in the treatment of RA when inflammation may be well controlled.
疼痛仍然是类风湿关节炎（RA）患者最重要的问题。活动性炎症性疾病会导致疼痛，但非炎症机制引起的疼痛会混淆疾病活动度的评估。我们假设，在类风湿关节炎中，疼痛处理增强、纤维肌痛特征、较差的心理健康状况以及患者报告的28关节疾病活动评分（DAS28）各组成部分之间存在关联。
从风湿病门诊招募了50名病情稳定、病程较长的类风湿关节炎患者，在三个不同部位（膝盖、胫骨和胸骨）评估其痛觉压力阈值（PPT）、DAS28、纤维肌痛和心理健康状况。进行多变量分析以评估PPT与DAS28各组成部分、DAS28-P（DAS28中源自患者报告的视觉模拟评分和压痛关节计数组成部分的比例）或纤维肌痛状态之间的关联。
关节上方或远处部位更敏感的PPT分别与报告的疼痛更严重、患者报告的DAS28各组成部分更高以及心理健康状况较差相关。高比例的参与者（48%）符合纤维肌痛的分类标准，纤维肌痛分类或特征分别与更敏感的PPT、患者报告的DAS28各组成部分更高以及心理健康状况较差相关。
在已确诊的类风湿关节炎中，对压力诱发疼痛的广泛敏感性、纤维肌痛特征的高患病率、患者报告的DAS28各组成部分更高以及心理健康状况较差均相互关联。非关节部位（胸骨和胫骨前部）以及关节上方的敏感性增加表明，中枢机制可能导致类风湿关节炎的疼痛敏感性。当炎症可能得到良好控制时，患者报告的组成部分对高DAS28的贡献应有助于指导类风湿关节炎治疗中改善病情或疼痛管理方法的决策。
