银屑病关节炎中的神经病理性疼痛：异常疼痛处理的证据。
Neuropathic-like pain in psoriatic arthritis: evidence of abnormal pain processing.
机构信息
School of Medicine, Cardiff University, Cardiff, UK.
CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Tenovus Building, Heath Park Campus, Cardiff, CF14 4XN, UK.
出版信息
Clin Rheumatol. 2019 Nov;38(11):3153-3159. doi: 10.1007/s10067-019-04656-5. Epub 2019 Jul 19.
OBJECTIVES
The primary objective was to investigate the prevalence of neuropathic-like pain in patients with psoriatic arthritis (PsA). Secondary outcomes were to investigate whether mood, fatigue, pain, disease severity and fibromyalgia are associated with neuropathic-like pain in PsA patients.
METHODS
PsA patients were assessed for fatigue, mood, pain, disease activity and fibromyalgia using questionnaires. Neuropathic-like pain was assessed by PainDetect.
RESULTS
Sixty-four patients with PsA were recruited from the Rheumatology Outpatient Department. Of the 64 patients recruited, 26.6% had 'likely neuropathic pain' and 21.9% had 'possible neuropathic-like pain' according to the PainDetect questionnaire. Patients with 'likely neuropathic pain' had higher disease activity, health assessment questionnaire, patient global self-assessment score, tender and swollen joint counts, dactylitis, enthesitis, pain severity and interference with day-to-day activities, fatigue severity and impact, fibromyalgia, anxiety and depression than 'unlikely neuropathic pain' patients (p < 0.05). PainDetect score correlated with measures of disease activity, fatigue, depression, anxiety, Widespread Pain Index and Symptom Severity Scale (all p < 0.05). Most patients (71%) with neuropathic-like pain fulfilled American College of Rheumatology 2010 fibromyalgia criteria. Patients with 'possible neuropathic-like pain' had scores between patients with 'likely neuropathic pain' and 'unlikely neuropathic pain'.
CONCLUSION
Neuropathic-like pain as evidence of abnormal pain processing is common in patients with PsA. It is associated with higher disease activity and fibromyalgia. A significant proportion of patients had 'possible neuropathic-like' pain with intermediate disease and symptom score suggesting neuropathic-like pain as evidence of abnormal pain processing is a continuum rather than concurrent fibromyalgia. Key Points • Neuropathic pain is prevalent in psoriatic arthritis. • Higher levels of pain, disease activity, fatigue, depression, anxiety and comorbidities in Psoriatic arthritis. • Increased pain severity is associated with increased disease activity, fatigue, depression and anxiety.
目的
主要目的是调查银屑病关节炎（PsA）患者中神经性疼痛的患病率。次要结局是调查情绪、疲劳、疼痛、疾病严重程度和纤维肌痛是否与 PsA 患者的神经性疼痛相关。
方法
使用问卷评估 PsA 患者的疲劳、情绪、疼痛、疾病活动度和纤维肌痛。通过 PainDetect 评估神经性疼痛。
结果
从风湿病门诊招募了 64 名 PsA 患者。根据 PainDetect 问卷，64 名入组患者中，26.6%有“可能的神经性疼痛”，21.9%有“可能的神经性样疼痛”。有“可能的神经性疼痛”的患者疾病活动度更高，健康评估问卷、患者总体自我评估评分、压痛和肿胀关节计数、指炎、肌腱端炎、疼痛严重程度和对日常活动的干扰、疲劳严重程度和影响、纤维肌痛、焦虑和抑郁程度均高于“不太可能的神经性疼痛”患者（p < 0.05）。PainDetect 评分与疾病活动度、疲劳、抑郁、焦虑、广泛疼痛指数和症状严重程度量表的测量值相关（均 p < 0.05）。大多数（71%）有神经性样疼痛的患者符合美国风湿病学会 2010 年纤维肌痛标准。有“可能的神经性样疼痛”的患者介于“可能的神经性疼痛”和“不太可能的神经性疼痛”患者之间。
结论
异常疼痛处理的神经性样疼痛作为证据在 PsA 患者中很常见。它与更高的疾病活动度和纤维肌痛有关。相当一部分患者有“可能的神经性样疼痛”，疾病和症状评分处于中间水平，这表明神经性样疼痛作为异常疼痛处理的证据是一个连续体，而不是并发的纤维肌痛。
关键点
神经性疼痛在银屑病关节炎中很常见。
银屑病关节炎患者的疼痛、疾病活动度、疲劳、抑郁、焦虑和合并症水平更高。
疼痛严重程度增加与疾病活动度、疲劳、抑郁和焦虑增加相关。
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