Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria n°1, 98100, Messina, Italy.
Division of Psychiatry, Department of Neuroscience, University of Messina, Messina, Italy.
Rheumatol Int. 2018 Mar;38(3):433-441. doi: 10.1007/s00296-017-3866-3. Epub 2017 Oct 30.
Pain perception and threshold show complex interactions with the inflammatory, psychiatric and neuroendocrine stimuli. This study aims to test whether lower serum cortisol levels are associated with lower pain thresholds and higher degree of depression in systemic sclerosis (SSc) and major depression with atypical features (MD-AF) patients compared to controls. 180 female subjects (SSc = 60, MD-AF = 60, healthy controls = 60) participated in this observational, cross-sectional, parallel group study. Pressure pain threshold (PPT) was assessed in three anatomical sites: nail bed (NB), metacarpophalangeal joint (MCP) and quadriceps muscle (QDR). Depressive symptoms were evaluated using the Beck Depression Inventory (BDI) scale and morning serum cortisol levels were collected. In SSc patients, quality of life was measured through the Health Assessment Questionnaire (HAQ-DI) and the scleroderma-specific visual analogue scales (scleroderma-VAS). Lower PPT scores (NB 4.42 ± 1.6; MCP 4.66 ± 1.4; QDR 4.79 ± 1.5) were observed in SSc patients compared to both MD-AF (NB 7.33 ± 2.2; MCP 6.01 ± 1.9; QDR 6.31 ± 1.6; p < 0.005) and controls (NB 9.57 ± 2; MCP 7.9 ± 2.1 and QDR 8.43 ± 2.1; p < 0.0001), while MD-AF patients had lower PPT scores compared to controls (p < 0.0001). SSc patients had also lower serum cortisol levels compared to MD-AF patients (8.78 vs 13.6 μg/dl; p < 0.05). A direct correlation was observed between serum cortisol and PPT scores both in SSc (r for NB 0.29; for MCP 0.25; for QDR 0.27) and in MD-AF (r for NB 0.34; for MCP 0.25; for QDR 0.47; p < 0.05), while depressive symptoms negatively correlated with serum cortisol (r for NB 0.34; for MCP 0.17; for QDR 0.15) and in MD-AF (r for NB 0.19; for MCP 0.31; for QDR 0.30; p < 0.05). Among SSc patients, those with serum cortisol levels below the normal range (n = 16) had higher BDI scores (15, 6-21 vs 9, 2-15; p < 0.005), lower PPTs (NB 4 ± 1.4 vs 4.9 ± 0.9; MCP 4.1 ± 0.8 vs 4.8 ± 0.9; QDR 4.1 ± 1.2 vs 5 ± 0.9; p < 0.005) and higher HAQ-DI (1.25, 0.25-2 vs 0.75, 0-1.25; p < 0.05) and scleroderma-VAS scores (VAS overall severity 7, 5.5-9.5 vs 4.5, 2.5-6; p < 0.05). The effect of cortisol serum levels upon pain mechanism, in chronic inflammatory conditions warrants longitudinal studies to detect treatable variations in pain thresholds, depressive symptoms and to improve quality of life.
疼痛感知和阈值与炎症、精神和神经内分泌刺激之间存在复杂的相互作用。本研究旨在测试系统性硬化症（SSc）和伴有非典型特征的重度抑郁症（MD-AF）患者的血清皮质醇水平是否与疼痛阈值降低和抑郁程度升高有关，与对照组相比。 180 名女性受试者（SSc=60，MD-AF=60，健康对照组=60）参与了这项观察性、横断面、平行组研究。在三个解剖部位评估压力疼痛阈值（PPT）：指甲床（NB）、掌指关节（MCP）和股四头肌（QDR）。使用贝克抑郁量表（BDI）评估抑郁症状，采集早晨血清皮质醇水平。在 SSc 患者中，通过健康评估问卷（HAQ-DI）和硬皮病特定视觉模拟量表（scleroderma-VAS）评估生活质量。与 MD-AF 患者（NB 7.33±2.2；MCP 6.01±1.9；QDR 6.31±1.6；p<0.005）和对照组（NB 9.57±2；MCP 7.9±2.1 和 QDR 8.43±2.1；p<0.0001）相比，SSc 患者的 PPT 评分较低（NB 4.42±1.6；MCP 4.66±1.4；QDR 4.79±1.5），而 MD-AF 患者的 PPT 评分较低与对照组（p<0.0001）。与 MD-AF 患者相比，SSc 患者的血清皮质醇水平也较低（8.78 与 13.6μg/dl；p<0.05）。在 SSc（r 对于 NB 0.29；对于 MCP 0.25；对于 QDR 0.27）和 MD-AF（r 对于 NB 0.34；对于 MCP 0.25；对于 QDR 0.47；p<0.05）中，观察到血清皮质醇与 PPT 评分之间存在直接相关性，而抑郁症状与血清皮质醇呈负相关（r 对于 NB 0.34；对于 MCP 0.17；对于 QDR 0.15）和 MD-AF（r 对于 NB 0.19；对于 MCP 0.31；对于 QDR 0.30；p<0.05）。在 SSc 患者中，血清皮质醇水平低于正常范围（n=16）的患者 BDI 评分较高（15，6-21 与 9，2-15；p<0.005），PPT 较低（NB 4±1.4 与 4.9±0.9；MCP 4.1±0.8 与 4.8±0.9；QDR 4.1±1.2 与 5±0.9；p<0.005）和更高的 HAQ-DI（1.25，0.25-2 与 0.75，0-1.25；p<0.05）和 scleroderma-VAS 评分（VAS 总体严重程度 7，5.5-9.5 与 4.5，2.5-6；p<0.05）。在慢性炎症状态下，皮质醇血清水平对疼痛机制的影响需要进行纵向研究，以检测疼痛阈值、抑郁症状和生活质量的可治疗变化。
