Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Eur J Pain. 2024 Feb;28(2):310-321. doi: 10.1002/ejp.2183. Epub 2023 Sep 15.
Chronic pain is the hallmark symptom of joint diseases. This study examined the differences in quantitative sensory testing between patients with psoriatic arthritis (PsA), hand osteoarthritis (hand-OA) and a pain-free control group and differences between patients with and without concomitant fibromyalgia (cFM).
All patients and pain-free controls were assessed using pressure pain thresholds (PPT), temporal summation of pain (TSP), conditioned pain modulation (CPM) and clinical pain intensities. Psychological distress was assessed with the Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and Pittsburgh Sleep Quality Index. Disability was assessed with the Health Assessment Questionnaire and pain quality with the painDETECT questionnaire. cFM was identified using the revised 2016 American College of Rheumatology diagnostic criteria.
Patients with hand-OA (n = 75) or PsA (n = 58) had statistically significant lower PPTs and CPM, greater TSP, and higher scores of psychological distress (p < 0.05) than controls (n = 20). Patients with cFM (58%) had higher scores of depression (p = 0.001), anxiety (p = 0.004), catastrophizing (p = 0.012), disability (p < 0.001), higher painDETECT score (p = 0.001), TSP (p = 0.027), and reduced sleep quality (p = 0.021) when compared to patients without cFM.
Patients with hand-OA and PsA exhibited signs of pain sensitization and a higher degree of psychological distress and disability than pain-free individuals. Patients with cFM had greater TSP, painDETECT score, disability, catastrophizing, and reduced sleep quality, than patients without, indicating greater degree of pain sensitization, psychological burden, and disability.
This paper shows that a significant proportion of patients with hand osteoarthritis and psoriatic arthritis with moderate pain intensity have significantly increased signs of pain sensitization and markers of psychological distress. A large proportion of these patients fulfil the criteria for concomitant fibromyalgia and these patients show even greater propensity towards pain sensitization and psychological distress.
慢性疼痛是关节疾病的主要症状。本研究检查了银屑病关节炎（PsA）、手部骨关节炎（手部 OA）患者与无疼痛对照组之间在定量感觉测试方面的差异，以及同时患有纤维肌痛（cFM）和不伴 cFM 患者之间的差异。
所有患者和无疼痛对照组均接受压力疼痛阈值（PPT）、疼痛时间总和（TSP）、条件疼痛调制（CPM）和临床疼痛强度评估。使用医院焦虑和抑郁量表、疼痛灾难化量表和匹兹堡睡眠质量指数评估心理困扰。使用健康评估问卷和疼痛 DETECT 问卷评估残疾和疼痛质量。使用修订后的 2016 年美国风湿病学会诊断标准确定 cFM。
手部 OA（n=75）或 PsA（n=58）患者的 PPT 和 CPM 明显低于对照组（n=20），TSP 较高，心理困扰评分较高（p<0.05）。58%的 cFM 患者抑郁评分（p=0.001）、焦虑评分（p=0.004）、灾难化评分（p=0.012）、残疾评分（p<0.001）、疼痛 DETECT 评分（p=0.001）、TSP（p=0.027）和睡眠质量评分（p=0.021）较高。
手部 OA 和 PsA 患者表现出疼痛敏化迹象，且与无疼痛个体相比，心理困扰和残疾程度更高。与无 cFM 的患者相比，有 cFM 的患者 TSP、疼痛 DETECT 评分、残疾、灾难化和睡眠质量降低程度更大，表明疼痛敏化、心理负担和残疾程度更大。
本文表明，相当一部分患有中度疼痛的手部骨关节炎和银屑病关节炎患者有明显增加的疼痛敏化迹象和心理困扰标志物。这些患者中有很大一部分符合同时患有纤维肌痛的标准，这些患者对疼痛敏化和心理困扰的倾向更大。
