Kılıçaslan Hamide Özge, Genç Aysun, Tuncer Safiye
Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Türkiye.
Turk J Phys Med Rehabil. 2022 Dec 14;69(1):89-96. doi: 10.5606/tftrd.2023.10470. eCollection 2023 Mar.
The aim of this study was to investigate central sensitization and associated factors in knee osteoarthritis (OA) patients and compare them with rheumatoid arthritis (RA) patients and healthy controls.
This cross-sectional study was conducted with 125 participants (7 males, 118 females; mean age: 57.2±8.2 years; range, 45 to 75 years) between January 2017 and December 2018. Sixty-two patients with symptomatic knee OA, 32 RA patients with knee pain, and 31 healthy controls constituted the participants. Central sensitization was investigated with the Central Sensitization Inventory (CSI) and pressure pain threshold (PPT) measurements. Pain, functional status, and psychosocial features were assessed with self-reported questionnaires.
The OA and RA groups had significantly lower PPT values at local, peripheral, and remote regions compared to the healthy controls. Pressure hyperalgesia was shown at the knee with a 43.5% prevalence, 27.4% at the leg, and 8.1% at the forearm of OA patients. Pressure hyperalgesia was present at the knee, leg, and forearm in 37.5%, 25%, and 9.4% of RA patients, respectively. Pressure pain threshold values, CSI scores, frequency of pressure hyperalgesia, and frequency of central sensitization according to the CSI were not statistically different between the OA and RA groups. Psychosocial features and structural damage were not correlated with PPT values in the OA group.
The severity of chronic pain and functional status may be the clinical clues to recognizing patients with central sensitization since local joint damage does not play a direct role in the etiopathogenesis of central sensitization in OA patients and severe pain persisting in the chronic process is associated with central sensitization regardless of the pathogenesis.
本研究旨在调查膝骨关节炎（OA）患者的中枢敏化及相关因素，并将其与类风湿关节炎（RA）患者和健康对照进行比较。
本横断面研究于2017年1月至2018年12月对125名参与者（7名男性，118名女性；平均年龄：57.2±8.2岁；范围45至75岁）进行。62例有症状的膝OA患者、32例有膝关节疼痛的RA患者和31名健康对照构成了研究对象。通过中枢敏化量表（CSI）和压力疼痛阈值（PPT）测量来调查中枢敏化情况。通过自我报告问卷评估疼痛、功能状态和心理社会特征。
与健康对照相比，OA组和RA组在局部、外周和远处区域的PPT值显著更低。OA患者中，膝关节压力性痛觉过敏的患病率为43.5%，腿部为27.4%，前臂为8.1%。RA患者中，膝关节、腿部和前臂压力性痛觉过敏的发生率分别为37.5%、25%和9.4%。OA组和RA组之间，根据CSI得出的压力疼痛阈值、CSI评分、压力性痛觉过敏频率和中枢敏化频率无统计学差异。心理社会特征和结构损伤与OA组的PPT值无关。
慢性疼痛的严重程度和功能状态可能是识别中枢敏化患者的临床线索，因为局部关节损伤在OA患者中枢敏化的病因发病机制中不发挥直接作用，且无论发病机制如何，慢性病程中持续存在的严重疼痛与中枢敏化相关。
