Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Boston University School of Medicine, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2023 Apr;75(4):778-784. doi: 10.1002/acr.24888. Epub 2022 Nov 9.
Many patients with rheumatoid arthritis (RA) experience sleep disturbances, commonly attributed to joint pain. Sleep disturbances could also influence pain. One mechanism may be through dysregulated pain processing, manifested by enhanced pain sensitivity. The present study was undertaken to examine the role of pain sensitization, measured by quantitative sensory testing (QST), as a mediator in the pathway of sleep disturbance leading to subsequent pain.
We used longitudinal data from 221 patients with active RA who were followed for 12 weeks after initiating a disease-modifying antirheumatic drug. Baseline QST included pressure pain thresholds at articular (wrists, knees) and nonarticular (trapezius, thumbnails) sites, temporal summation (TS) at the wrist and forearm, and conditioned pain modulation (CPM). Baseline sleep disturbance and subsequent pain intensity were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS). We evaluated correlations between sleep disturbance, QSTs, and subsequent pain intensity. Mediation analyses separately assessed each QST as a mediator, adjusting for baseline confounding factors.
Sleep disturbance was correlated with all QST measures except wrist TS and CPM. Sleep disturbance significantly predicted subsequent pain (coefficient for a meaningful increase of 5 units in sleep disturbance = 0.32 (95% confidence interval 0.11, 0.50) in multiple regression. QST mediated 10-19% of this effect.
Pain sensitization may be one mechanism through which sleep disturbance contributes to pain. The small magnitude of association indicates that unmeasured pathways may contribute to this relationship. Intervention studies are needed to establish causality and determine whether improving sleep can improve pain in patients with RA.
许多类风湿关节炎（RA）患者存在睡眠障碍，通常归因于关节疼痛。睡眠障碍也可能影响疼痛。本研究旨在探讨疼痛敏化（通过定量感觉测试（QST）测量）作为睡眠障碍导致随后疼痛的途径中的中介作用。
我们使用了 221 例活动性 RA 患者的纵向数据，这些患者在开始使用疾病修饰抗风湿药物后 12 周内进行了随访。基线 QST 包括关节（手腕、膝盖）和非关节（斜方肌、指甲）部位的压痛阈值、手腕和前臂的时间总和（TS）以及条件性疼痛调节（CPM）。使用患者报告的结局测量信息系统（PROMIS）评估基线睡眠障碍和随后的疼痛强度。我们评估了睡眠障碍、QST 和随后的疼痛强度之间的相关性。中介分析分别评估了每个 QST 作为中介的作用，调整了基线混杂因素。
睡眠障碍与除腕部 TS 和 CPM 外的所有 QST 测量值相关。睡眠障碍显著预测随后的疼痛（睡眠障碍增加 5 个单位的回归系数为 0.32（95%置信区间 0.11，0.50）。QST 介导了 10-19%的这种效应。
疼痛敏化可能是睡眠障碍导致疼痛的一种机制。关联的幅度较小表明，未测量的途径可能对这种关系有贡献。需要干预研究来确定因果关系，并确定改善睡眠是否可以改善 RA 患者的疼痛。
