轴性脊柱关节炎中疾病活动、中枢敏化、心理社会因素及生活方式因素之间的相互关系
Interrelationships of disease activity, central sensitization, psychosocial and lifestyle factors in axial spondyloarthritis.
作者信息
Kieskamp Stan C, van der Kraan Yvonne, Arends Suzanne, Wink Fréke, Bos Reinhard, Stewart Roy, Paap Davy, Spoorenberg Anneke
机构信息
Department of Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands.
Department of Rheumatology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
出版信息
Rheumatology (Oxford). 2025 Jun 1;64(6):3547-3555. doi: 10.1093/rheumatology/keaf102.
OBJECTIVES
In a substantial portion of patients with axial SpA (axSpA), disease activity scores remain high despite anti-inflammatory treatment. This is possibly due to factors beyond active inflammation including different pain mechanisms and psychosocial factors. Therefore, our aim was to build a biopsychosocial model to explore the interrelationships of Axial Spondyloarthritis Disease Activity Score (ASDAS) with central sensitization, psychological and lifestyle factors in patients with axSpA.
METHODS
Consecutive patients from the prospective Groningen Leeuwarden axSpA (GLAS) cohort were included in this cross-sectional study. Assessments included in the model were educational level, BMI, questionnaires on central sensitization, illness perception, pain catastrophizing, coping, anxiety and depression, physical activity (modified Short QUestionnaire to ASsess Health-enhancing physical activity, mSQUASH) and ASDAS. Structural equation modelling (SEM), a multivariate analysis testing hypothesized interrelationships between variables, was applied to investigate the effects of central sensitization, psychosocial and lifestyle factors on ASDAS.
RESULTS
A total of 332 consecutive axSpA patients were eligible for analyses, of whom 59% were male; median symptom duration was 21 years and mean ASDAS was 2.2 ± 0.9. The final SEM model had a satisfactory fit [root mean square error of approximation = 0.057 (95% CI 0.45-0.70), comparative fit index = 0.936]. Illness perception, central sensitization and BMI had direct, significant, effects on ASDAS. Psychological well-being and educational level were significantly indirectly associated with ASDAS through illness perception.
CONCLUSION
Our analyses exploring the interrelationships of biopsychosocial factors related to ASDAS showed that factors beyond inflammation, especially illness perception and central sensitization, seem to contribute significantly to ASDAS in patients treated for axSpA in our standard-of-care cohort, confirming the need for a biopsychosocial approach.
目的
在相当一部分中轴型脊柱关节炎（axSpA）患者中，尽管接受了抗炎治疗，疾病活动评分仍居高不下。这可能是由于除了活动性炎症之外的因素，包括不同的疼痛机制和社会心理因素。因此，我们的目的是建立一个生物心理社会模型，以探讨中轴型脊柱关节炎疾病活动评分（ASDAS）与axSpA患者的中枢敏化、心理和生活方式因素之间的相互关系。
方法
本横断面研究纳入了前瞻性格罗宁根吕伐登axSpA（GLAS）队列中的连续患者。模型中的评估包括教育水平、体重指数、关于中枢敏化、疾病认知、疼痛灾难化、应对方式、焦虑和抑郁的问卷、身体活动（改良的简短健康增强身体活动问卷，mSQUASH）和ASDAS。应用结构方程模型（SEM），一种检验变量间假设相互关系的多变量分析方法，来研究中枢敏化、社会心理和生活方式因素对ASDAS的影响。
结果
共有332例连续的axSpA患者符合分析条件，其中59%为男性；症状持续时间中位数为21年，平均ASDAS为2.2±0.9。最终的SEM模型拟合良好[近似均方根误差=0.057（95%CI 0.45 - 0.70），比较拟合指数=0.936]。疾病认知、中枢敏化和体重指数对ASDAS有直接、显著的影响。心理健康和教育水平通过疾病认知与ASDAS显著间接相关。
结论
我们对与ASDAS相关的生物心理社会因素之间相互关系的分析表明，炎症以外的因素，尤其是疾病认知和中枢敏化，似乎在我们的标准治疗队列中接受治疗的axSpA患者的ASDAS中起重要作用，证实了采用生物心理社会方法治疗的必要性。
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