Division of Rheumatology and Research, Diakonhjemmet Hospital.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Rheumatology (Oxford). 2022 May 30;61(6):2316-2324. doi: 10.1093/rheumatology/keab708.
Pain sensitization is associated with pain severity in persons with hand OA. What contributes to pain sensitization is unclear. This study explores whether hand OA pathologies and symptom duration are related to central sensitization.
Participants with hand OA in the Nor-Hand study underwent bilateral hand radiography and US examination. Central sensitization was assessed with pressure pain thresholds (PPT) at remote sites (wrist, trapezius and tibialis anterior muscles) and temporal summation. We examined whether hand OA pathologies, independent of each other, including structural severity (Kellgren-Lawrence sum score, presence of erosive hand OA), inflammatory severity (greyscale synovitis and power Doppler activity sum scores) and symptom duration, were related to central sensitization, adjusting for age, sex, BMI, comorbidities and OA-severity of knee/hip.
In 291 participants (88% women, median age 61 years, interquartile range 57-66 years) Kellgren-Lawrence, greyscale synovitis and power Doppler activity sum scores were not associated with lower PPTs at remote sites. Persons with erosive hand OA had lower PPTs at the wrist (adjusted beta -0.75, 95% CI -1.32, -0.19) and tibialis anterior (adjusted beta -0.82, 95% CI -1.54, -0.09) and had greater temporal summation (adjusted beta 0.56, 95% CI 0.12, 1.01) compared with persons with non-erosive disease. No associations were found for symptom duration.
A person's overall amount of structural or inflammatory hand OA pathologies was not associated with central sensitization. Although persons with erosive hand OA showed greater signs of central sensitization, the small differences suggest that central sensitization is mainly explained by factors other than joint pathologies.
在手部 OA 患者中，疼痛敏化与疼痛严重程度相关。导致疼痛敏化的原因尚不清楚。本研究探讨手部 OA 病变和症状持续时间是否与中枢敏化有关。
Nor-Hand 研究中的手部 OA 患者接受双侧手部 X 线摄影和超声检查。通过在远程部位（腕部、斜方肌和胫骨前肌）和时间总和评估压力疼痛阈值（PPT）来评估中枢敏化。我们研究了手部 OA 病变（包括结构性严重程度[Kellgren-Lawrence 总和评分、存在侵蚀性手部 OA]、炎症严重程度[灰度滑膜炎症和功率多普勒活动总和评分]）是否与中枢敏化相关，这些病变相互独立，并调整了年龄、性别、BMI、合并症和膝/髋 OA 严重程度。
在 291 名参与者（88%为女性，中位年龄 61 岁，四分位间距 57-66 岁）中，Kellgren-Lawrence、灰度滑膜炎症和功率多普勒活动总和评分与远程部位较低的 PPT 无关。患有侵蚀性手部 OA 的患者腕部（校正后β-0.75，95%CI-1.32，-0.19）和胫骨前肌（校正后β-0.82，95%CI-1.54，-0.09）的 PPT 较低，且时间总和较大（校正后β0.56，95%CI0.12，1.01）与非侵蚀性疾病患者相比。症状持续时间无相关性。
一个人整体的结构性或炎症性手部 OA 病变数量与中枢敏化无关。尽管患有侵蚀性手部 OA 的患者表现出更大的中枢敏化迹象，但差异较小表明中枢敏化主要由关节病变以外的因素解释。
