Adami Giovanni, Gerratana Elisabetta, Atzeni Fabiola, Benini Camilla, Vantaggiato Elisabetta, Rotta Denise, Idolazzi Luca, Rossini Maurizio, Gatti Davide, Fassio Angelo
Rheumatology Unit, University of Verona, Verona, Italy.
Rheumatology Unit, University of Messina, Messina, Italy.
Ther Adv Musculoskelet Dis. 2021 Feb 15;13:1759720X21993252. doi: 10.1177/1759720X21993252. eCollection 2021.
Central sensitization (CS) is a condition characterized by a disproportionate response to pain stimuli. We sought to investigate the prevalence of CS in patients with inflammatory arthritides and its association with measures of disease activity and functional disability.
We conducted an observational retrospective study in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) patients. We administered to all the subjects in the study the CS inventory (CSI), a questionnaire that has been used for the diagnosis of CS. Demographic and clinical characteristics were collected as well as measures or disease activity [i.e. Simple Disease Activity Index, Disease Activity Score in PsA (DAPSA)] and functional disability [Health Assessment Questionnaire Disability Index (HAQ-DI)]. Patients with fibromyalgia were excluded from the analyses. The primary outcome measure was the presence of functional disability as assessed by HAQ-DI >1.
We enrolled 150 patients with inflammatory arthritides (78 PsA and 72 RA). Prevalence of CS was observed in 35.3% of the overall sample (29% in RA, 42.9% in PsA). Binary logistic regressions showed a strong, independent and linear association between functional disability and CS in both PsA and RA patients. The strength of this association was greater in PsA than in RA.
CS is an important determinant of functional disability in patients with chronic inflammatory arthritides. PsA appeared to be more vulnerable to CS. In addition, in the presence of CS, DAPSA did not adequately capture the occurrence of functional disability. Therefore, special attention should be paid to PsA patients, in whom the concomitant diagnosis of CS should be routinely ruled out.
中枢敏化（CS）是一种以对疼痛刺激反应过度为特征的病症。我们试图调查炎症性关节炎患者中CS的患病率及其与疾病活动度和功能残疾指标的关联。
我们对银屑病关节炎（PsA）和类风湿关节炎（RA）患者进行了一项观察性回顾性研究。我们对研究中的所有受试者进行了CS量表（CSI）评估，该量表是一种用于诊断CS的问卷。收集了人口统计学和临床特征以及疾病活动度指标[即简化疾病活动指数、PsA疾病活动评分（DAPSA）]和功能残疾指标[健康评估问卷残疾指数（HAQ-DI）]。纤维肌痛患者被排除在分析之外。主要结局指标是通过HAQ-DI>1评估的功能残疾的存在情况。
我们纳入了150例炎症性关节炎患者（78例PsA和72例RA）。在整个样本中观察到CS的患病率为35.3%（RA中为29%，PsA中为42.9%）。二元逻辑回归显示，在PsA和RA患者中，功能残疾与CS之间存在强烈、独立且呈线性的关联。这种关联在PsA中比在RA中更强。
CS是慢性炎症性关节炎患者功能残疾的重要决定因素。PsA似乎更容易受到CS的影响。此外，在存在CS的情况下，DAPSA不能充分反映功能残疾的发生情况。因此，应特别关注PsA患者，对于他们应常规排除CS的合并诊断。
