Ito Satoshi, Kobayashi Daisuke, Murasawa Akira, Narita Ichiei, Nakazono Kiyoshi
Department of Rheumatology, Niigata Rheumatic Center, Japan.
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
Intern Med. 2018 Feb 15;57(4):479-485. doi: 10.2169/internalmedicine.9235-17. Epub 2017 Dec 8.
Objective To analyze the neuropathic pain (NeP) components in patients with rheumatoid arthritis (RA). Methods The painDETECT questionnaire (PD-Q) was completed by 300 RA patients (79 men, 221 women). Results Nine patients (3.0%) were categorized as likely NeP, 33 (11.0%) were categorized as possible NeP, and 258 (86.0%) were categorized as unlikely NeP. When we excluded patients with diabetes mellitus, spinal diseases, neurological diseases, and herpes zoster infection (conditions associated with NeP), 5 of the patients (1.7%) had likely NeP, and 23 (7.7%) had possible NeP without any underlying conditions. Furthermore, there were no marked differences in the percentages of these underlying conditions among the patients with likely, possible, and unlikely NeP. When we compared patients with likely and possible NeP (n=42) and unlikely NeP (n=258), the body mass index (BMI), disease activity score-28 based on the erythrocyte sedimentation rate, C-reactive protein level, pain visual analogue scale (VAS), and PD-Q score were significantly higher in the patients with likely and possible NeP than in those with unlikely NeP. A multivariate analysis showed that BMI ≥22 and not being in clinical remission were associated with NeP. Conclusion Although RA pain has usually been classified as nociceptive pain, the present study clarified that a significant number of patients might have NeP. The present findings suggest that high disease activity and being overweight are related to NeP in RA patients.
目的 分析类风湿关节炎（RA）患者的神经性疼痛（NeP）成分。方法 300例RA患者（79例男性，221例女性）完成了疼痛检测问卷（PD-Q）。结果 9例患者（3.0%）被归类为可能患有NeP，33例（11.0%）被归类为可能患有NeP，258例（86.0%）被归类为不太可能患有NeP。当我们排除患有糖尿病、脊柱疾病、神经疾病和带状疱疹感染（与NeP相关的疾病）的患者后，5例患者（1.7%）可能患有NeP，23例（7.7%）可能患有NeP且无任何潜在疾病。此外，在可能、可能患有和不太可能患有NeP的患者中，这些潜在疾病的百分比没有显著差异。当我们比较可能患有和可能患有NeP的患者（n=42）和不太可能患有NeP的患者（n=258）时，可能患有和可能患有NeP的患者的体重指数（BMI）、基于红细胞沉降率的疾病活动评分-28、C反应蛋白水平、疼痛视觉模拟量表（VAS）和PD-Q评分显著高于不太可能患有NeP的患者。多因素分析表明，BMI≥22且未处于临床缓解状态与NeP相关。结论 尽管RA疼痛通常被归类为伤害性疼痛，但本研究表明，相当数量的患者可能患有NeP。目前的研究结果表明，高疾病活动度和超重与RA患者的NeP有关。
