Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Boston University School of Medicine, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2023 Dec;75(12):2472-2480. doi: 10.1002/acr.25178. Epub 2023 Aug 3.
Women with rheumatoid arthritis (RA) have higher pain and worse functional outcomes compared to men, even when treated with similar medications. The objective of this study was to identify sex differences in pain intensity, pain interference, and quantitative sensory tests (QST), which are independent of inflammation, in patients with RA.
This study is a post hoc analysis of participants in the Central Pain in Rheumatoid Arthritis cohort. Pain intensity was assessed using a 0-10 numeric rating scale. Pain interference was measured using a Patient-Reported Outcomes Measurement Information System computerized adaptive test. QST included pressure pain detection thresholds, temporal summation, and conditioned pain modulation. Women and men were compared using multiple linear regression, adjusted for age, education, race, research site, depression, obesity, RA disease duration, swollen joint count, and C-reactive protein.
Mean ± SD pain intensity was 5.32 ± 2.29 among women with RA, compared to 4.60 ± 2.23 among men with RA (adjusted difference 0.83 [95% confidence interval (95% CI) 0.14, 1.53]). Women with RA had lower pressure pain detection thresholds at the trapezius (adjusted difference -1.22 [95% CI -1.73, -0.72]), wrist (adjusted difference -0.57 [95% CI -1.07, -0.06]), and knee (adjusted difference -1.10 [95% CI -2.00, -0.21]). No statistically significant differences in pain interference, temporal summation, and conditioned pain modulation were observed.
Women reported higher pain intensity and lower pressure pain detection thresholds (higher pain sensitivity) than men. However, pain interference, temporal summation, and conditioned pain modulation did not differ between men and women.
与接受相似药物治疗的男性患者相比，类风湿关节炎（RA）女性患者的疼痛程度更高，功能结局更差。本研究旨在确定 RA 患者疼痛强度、疼痛干扰和定量感觉测试（QST）方面的性别差异，这些差异与炎症无关。
本研究是中央类风湿关节炎疼痛队列研究参与者的事后分析。疼痛强度采用 0-10 数字评分量表进行评估。疼痛干扰采用患者报告的结局测量信息系统计算机自适应测试进行测量。QST 包括压力疼痛检测阈值、时间总和和条件性疼痛调节。采用多元线性回归比较女性和男性，调整年龄、教育程度、种族、研究地点、抑郁、肥胖、RA 疾病持续时间、肿胀关节计数和 C 反应蛋白。
RA 女性患者的平均±标准差疼痛强度为 5.32±2.29，而 RA 男性患者为 4.60±2.23（调整后差异 0.83[95%置信区间（95%CI）0.14，1.53]）。RA 女性患者斜方肌（调整后差异-1.22[95%CI-1.73，-0.72]）、腕部（调整后差异-0.57[95%CI-1.07，-0.06]）和膝关节（调整后差异-1.10[95%CI-2.00，-0.21]）的压力疼痛检测阈值较低。疼痛干扰、时间总和和条件性疼痛调节未见统计学差异。
与男性相比，女性报告的疼痛强度更高，压力疼痛检测阈值更低（疼痛敏感性更高）。然而，男性和女性之间的疼痛干扰、时间总和和条件性疼痛调节没有差异。
