基于人群的脊柱关节炎患者队列中慢性广泛性疼痛的患病率——一项横断面研究
Prevalence of chronic widespread pain in a population-based cohort of patients with spondyloarthritis - a cross-sectional study.
作者信息
Mogard Elisabeth, Bremander Ann, Lindqvist Elisabet, Bergman Stefan
机构信息
Department of Clinical Sciences Lund, Rheumatology, Lund University, Skane University Hospital, Lund, Sweden.
2Department of Clinical Sciences Lund,Rheumatology, Lund University, Faculty of Medicine, Lund, Sweden.
出版信息
BMC Rheumatol. 2018 Apr 5;2:11. doi: 10.1186/s41927-018-0018-7. eCollection 2018.
BACKGROUND
Chronic pain, regional or widespread, is a frequent and multidimensional symptom in arthritis. There is still limited information on chronic pain in spondyloarthritis, which is important to recognize for adequate diagnosis and treatment. Our objective was to study differences in prevalence of chronic widespread pain in two spondyloarthritis subgroups: ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA).
METHODS
A population-based postal survey involving questions on the duration, distribution, and intensity of pain was answered by 940 patients with AS (ICD-10 M45.9) or USpA (ICD-10 M46.1-0, M46.8-9). The patients were categorized as having chronic widespread pain, chronic regional pain, or no chronic pain, and prevalence estimates for the pain groups were calculated, including age- and sex-adjusted prevalence.
RESULTS
The prevalence of chronic widespread pain was 45.3% in AS vs. 49.3% in USpA, and that of chronic regional pain was 17.7% vs. 21.9% ( = 0.033). More women than men reported having chronic widespread pain (54.1% vs. 41.2%, ≤ 0.001), while the sex distribution for chronic regional pain was equal. Reports of pain intensity were equal in AS and USpA, with no significant difference in pain intensity between women and men who had chronic regional pain or chronic widespread pain. In the multiple logistic regression analysis, chronic widespread pain was associated to female sex, being an ever-smoker, and having a higher body mass index, controlled for SpA subgroup and disease duration.
CONCLUSIONS
The prevalence of chronic widespread pain in patients with AS and USpA is high, and with a female predominance, but with no difference in pain intensity between women and men. Chronic pain can complicate the clinical evaluation in patients with SpA, and highlights the need for a thorough clinical examination, including evaluation of inflammation and an accurate pain analysis, to individualize non-pharmacological and pharmacological treatment decisions.
背景
慢性疼痛，无论是局部性还是全身性的，都是关节炎中常见的多维度症状。关于脊柱关节炎中慢性疼痛的信息仍然有限，而认识到这一点对于充分的诊断和治疗很重要。我们的目的是研究两个脊柱关节炎亚组：强直性脊柱炎（AS）和未分化脊柱关节炎（USpA）中慢性全身性疼痛患病率的差异。
方法
一项基于人群的邮寄调查，涉及有关疼痛持续时间、分布和强度的问题，940例AS（国际疾病分类第十版M45.9）或USpA（国际疾病分类第十版M46.1 - 0，M46.8 - 9）患者进行了回答。患者被分类为患有慢性全身性疼痛、慢性局部疼痛或无慢性疼痛，并计算了疼痛组的患病率估计值，包括年龄和性别调整后的患病率。
结果
AS患者中慢性全身性疼痛的患病率为45.3%，而USpA患者中为49.3%，慢性局部疼痛的患病率分别为17.7%和21.9%（P = 0.033）。报告患有慢性全身性疼痛的女性多于男性（54.1%对41.2%，P≤0.001），而慢性局部疼痛的性别分布相同。AS和USpA患者的疼痛强度报告相同，患有慢性局部疼痛或慢性全身性疼痛的女性和男性之间的疼痛强度无显著差异。在多元逻辑回归分析中，控制SpA亚组和病程后，慢性全身性疼痛与女性性别、曾经吸烟以及较高的体重指数相关。
结论
AS和USpA患者中慢性全身性疼痛的患病率很高，且以女性为主，但女性和男性之间的疼痛强度无差异。慢性疼痛会使SpA患者的临床评估复杂化，并突出了进行全面临床检查的必要性，包括炎症评估和准确的疼痛分析，以个体化非药物和药物治疗决策。
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