中轴型脊柱关节炎患者的中枢敏感指数评估价值。
Value of the central sensitisation inventory in patients with axial spondyloarthritis.
机构信息
Department of Rheumatology and Clinical Immunology, University Medical Centre, Groningen, Netherlands
Department of Rheumatology and Clinical Immunology, University Medical Centre, Groningen, Netherlands.
出版信息
RMD Open. 2024 Oct 28;10(4):e004528. doi: 10.1136/rmdopen-2024-004528.
BACKGROUND
In many patients with axial spondyloarthritis (axSpA), pain persists despite anti-inflammatory medication. Quantitative sensory testing (QST) indirectly assesses altered somatosensory function, though its clinical practicality is limited. The Central Sensitisation Inventory (CSI) could be an alternative in the initial assessment of central sensitisation (CS). This study aimed to investigate the value of the CSI in evaluating CS in patients with axSpA by (1) assessing somatosensory function related to CS with QST and (2) exploring associations between CSI, QST, patient and disease characteristics and pain-related psychosocial factors.
METHODS
Consecutive outpatients from the Groningen Leeuwarden AxSpA cohort underwent QST, including pressure pain threshold (PPT), temporal summation (TS) and conditioned pain modulation (CPM). Participants completed questionnaires assessing CS (CSI), illness perception (Revised Illness Perception Questionnaire, IPQ-R), pain-related worrying (Pain Catastrophising Scale, PCS), fatigue (Modified Fatigue Impact Scale, MFIS), anxiety/depression (Hospital Anxiety and Depression Scale, HADS) and coping. QST measurements were stratified for CSI≥40.
RESULTS
201 patients with axSpA were included; 63% male, 64% radiographic axSpA, median symptom duration 12 years (IQR 5-24), mean Axial Spondyloarthritis Disease Activity Score 2.1±1.0. Patients with CSI≥40 had significantly lower PPTs and higher TS than CSI<40 (p<0.004). No significant differences in CPM were observed. In multivariable linear regression, sex, PCS, IPQ-R Identity, MFIS and HADS anxiety were independently associated with CSI (78% explained variance).
CONCLUSION
In this large cross-sectional study in patients with axSpA, the CSI appears as a useful initial CS assessment questionnaire. When CSI scores indicate CS, considering pain-related psychosocial factors is important. These results emphasise the need for a biopsychosocial approach to manage chronic pain in patients with axSpA.
背景
在许多患有中轴型脊柱关节炎（axSpA）的患者中，尽管使用了抗炎药物，疼痛仍持续存在。定量感觉测试（QST）间接评估感觉功能改变，但其实用性有限。中枢敏化量表（CSI）可能是评估中枢敏化（CS）的初始替代方法。本研究旨在通过（1）使用 QST 评估与 CS 相关的感觉功能，以及（2）探讨 CSI、QST、患者和疾病特征与疼痛相关的心理社会因素之间的关联，来研究 CSI 在评估 axSpA 患者 CS 中的价值。
方法
格罗宁根-吕伐登 axSpA 队列的连续门诊患者接受了 QST，包括压力疼痛阈值（PPT）、时间总和（TS）和条件性疼痛调制（CPM）。参与者完成了评估 CS（CSI）、疾病感知（修订后的疾病感知问卷，IPQ-R）、疼痛相关担忧（疼痛灾难化量表，PCS）、疲劳（改良疲劳影响量表，MFIS）、焦虑/抑郁（医院焦虑和抑郁量表，HADS）和应对的问卷。根据 CSI≥40 将 QST 测量值分层。
结果
共纳入 201 例 axSpA 患者；男性占 63%，放射学 axSpA 占 64%，中位症状持续时间为 12 年（IQR 5-24），平均 Axial Spondyloarthritis Disease Activity Score 为 2.1±1.0。CSI≥40 的患者的 PPT 明显低于 CSI<40 的患者（p<0.004），而 CPM 无显著差异。在多变量线性回归中，性别、PCS、IPQ-R 身份、MFIS 和 HADS 焦虑与 CSI 独立相关（解释方差 78%）。
结论
在这项针对 axSpA 患者的大型横断面研究中，CSI 似乎是一种有用的初始 CS 评估问卷。当 CSI 评分提示 CS 时，考虑疼痛相关的心理社会因素很重要。这些结果强调了对 axSpA 患者慢性疼痛进行生物-心理-社会管理的必要性。
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