INSERM U987, Paris, France; Centre d'évaluation et traitement de la douleur, GHU Paris centre-Cochin, Paris, France; Université de Paris, Paris, France.
INSERM U987, Paris, France; Centre d'évaluation et traitement de la douleur, GHU Paris-Île-de-France Ouest-Ambroise-Paré, Boulogne-Billancourt, France; Université Versailles-Saint-Quentin, Versailles, France.
Joint Bone Spine. 2022 Oct;89(5):105399. doi: 10.1016/j.jbspin.2022.105399. Epub 2022 Apr 30.
The major therapeutic challenge in inflammatory rheumatic diseases is the persistence of pain despite good responses to specific therapies. Central sensitization, which can be assessed clinically by psychophysical measurements, including quantitative sensory testing (QST), is a widely proposed mechanism for chronic pain. In this systematic review, we explored the scientific literature addressing quantitative sensory testing in inflammatory rheumatic diseases. We searched Pubmed and Embase for publications up to December 2021 concerning studies on quantitative sensory testing focusing on pain thresholds, temporal summation (TS) and conditioned pain modulation (CPM), in adult patients with chronic inflammatory rheumatism (e.g. rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, juvenile idiopathic arthritis). The exclusion criteria were reviews, inclusion of children and no reported pain threshold. Data quality was assessed with the National Institutes of Health (NIH) Quality Assessment tools. We identified 27 studies (18 controlled, 9 uncontrolled) including 1875 patients with inflammatory rheumatic diseases and 795 controls. A decrease in pressure pain threshold, in favor of allodynia, was found in 12 of 14 controlled studies on patients with rheumatoid arthritis and spondyloarthritis. The results of other psychophysical tests, including TS and CPM, were inconsistent due to population heterogeneity and a lack of standardization of the patients' disease duration, activity and treatment. Our review shows that pain in chronic inflammatory rheumatism is associated with pressure allodynia. However, given the heterogeneous quality and discrepant results of studies of other QST outcome measures, the hypothesis of central sensitization involvement in pain processing in these patients cannot be confirmed.
在炎症性风湿病中，主要的治疗挑战是尽管对特定疗法有良好反应，但仍持续存在疼痛。通过包括定量感觉测试（QST）在内的心理物理学测量可以临床评估的中枢敏化，是慢性疼痛的广泛提出的机制。在本系统评价中，我们探索了涉及炎症性风湿病中定量感觉测试的科学文献。我们在 Pubmed 和 Embase 上搜索了截至 2021 年 12 月的出版物，这些出版物涉及针对慢性炎症性风湿病（例如类风湿关节炎、脊柱关节炎、银屑病关节炎、幼年特发性关节炎）的成年患者的疼痛阈值、时间总和（TS）和条件疼痛调制（CPM）的定量感觉测试研究。排除标准为综述、纳入儿童和未报告疼痛阈值。使用美国国立卫生研究院（NIH）质量评估工具评估数据质量。我们确定了 27 项研究（18 项对照，9 项非对照），包括 1875 例炎症性风湿病患者和 795 例对照。在 14 项针对类风湿关节炎和脊柱关节炎患者的对照研究中，有 12 项研究发现压力疼痛阈值降低，有利于感觉过敏。由于人群异质性和患者疾病持续时间、活动和治疗缺乏标准化，其他心理物理学测试（包括 TS 和 CPM）的结果不一致。我们的综述表明，慢性炎症性风湿病中的疼痛与压力感觉过敏有关。然而，鉴于其他 QST 结果测量研究的质量和结果存在差异，无法证实这些患者疼痛处理中涉及中枢敏化的假设。
