Elisabeth Mogard1, Tor Olofsson1, Stefan Bergman1, Ann Bremander1, Lars-Erik Kristensen1, Jack Kvistgaard Olsen1, Johan K Wallman1, Elisabet Lindqvist1. 1. This work was supported by grants from the Faculty of Medicine at Lund University; Region Skåne; Skåne University Hospital; Spenshult Research and Development Centre; ALF Region Skåne; the Swedish Rheumatism Association; the Anna-Greta Crafoord Foundation; the Kock Foundation; the Österlund Foundation; and the Lundgren Foundation. E. Mogard, PT, PhD, T. Olofsson, MD, PhD, J.K. Wallman, MD, PhD, E. Lindqvist, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, and Skåne University Hospital, Department of Rheumatology, Lund, Sweden; S. Bergman, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, and Spenshult Research and Development Centre, Halmstad, Sweden; A. Bremander, PT, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Spenshult Research and Development Centre, Halmstad, Sweden, Department of Regional Health Research, University of Southern Denmark, Odense, and Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark; L.E. Kristensen, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden, and The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark; J. Kvistgaard Olsen, BSc, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark. TO has received interview fees from Eli Lilly and provided consultancy for Merck & Co. (unrelated to the present work). LEK has received consultancy and speakers bureau fees from AbbVie, Amgen, Biogen, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Merck & Co., Novartis, Pfizer; Roche, Sanofi, and UCB (unrelated to the present work). JKW has received consultancy fees from AbbVie, Celgene, Eli Lilly, Novartis, and UCB (unrelated to the present work). The remaining authors have no competing interests. Address correspondence to Dr. E. Mogard, Department of Rheumatology, Skåne University Hospital, Kioskgatan 5, SE-221 85 Lund, Sweden. Email: elisabeth.mogard@med.lu.se. Accepted for publication December 4, 2020.
Abstract
OBJECTIVE: To study differences in pain reports between patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA), and to assess how pain sensitivity measures associate with disease and health outcomes. METHODS: Consecutive patients with axial SpA (axSpA) were enrolled in the population-based SPARTAKUS cohort (2015-2017) and classified as AS (n = 120) or nr-axSpA (n = 55). Pain was assessed with questionnaires (intensity/duration/distribution) and computerized cuff pressure algometry to measure pain sensitivity (pain threshold/pain tolerance/temporal summation of pain). Linear regression models were used to compare pain measures between patients with AS and nr-axSpA, and to assess associations between pain sensitivity measures and disease and health outcomes. RESULTS: Of 175 patients with axSpA, 43% reported chronic widespread pain, with no significant differences in any questionnaire-derived or algometry-assessed pain measures between patients with AS and nr-axSpA. Lower pain tolerance was associated with longer symptom duration, worse Ankylosing Spondylitis Disease Activity Score using C-reactive protein (ASDAS-CRP), Bath Ankylosing Spondylitis Functional Index, and Bath Ankylosing Spondylitis Metrology Index (BASMI), more pain regions, unacceptable pain, worse Maastricht AS Enthesitis Score (MASES), fatigue, anxiety, and health-related quality of life. Further, lower pain threshold was associated with worse ASDAS-CRP and MASES, whereas higher temporal summation was associated with longer symptom duration, unacceptable pain, and worse BASMI. CONCLUSION: Chronic pain is common in axSpA, with no observed differences in any pain measures between patients with AS and nr-axSpA. Further, higher pain sensitivity is associated with having worse disease and health outcomes. The results indicate that patients with AS and nr-axSpA, in line with most clinical characteristics, have a similar pain burden, and they highlight large unmet needs regarding individualized pain management, regardless of axSpA subgroup.
OBJECTIVE: To study differences in pain reports between patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA), and to assess how pain sensitivity measures associate with disease and health outcomes. METHODS: Consecutive patients with axial SpA (axSpA) were enrolled in the population-based SPARTAKUS cohort (2015-2017) and classified as AS (n = 120) or nr-axSpA (n = 55). Pain was assessed with questionnaires (intensity/duration/distribution) and computerized cuff pressure algometry to measure pain sensitivity (pain threshold/pain tolerance/temporal summation of pain). Linear regression models were used to compare pain measures between patients with AS and nr-axSpA, and to assess associations between pain sensitivity measures and disease and health outcomes. RESULTS: Of 175 patients with axSpA, 43% reported chronic widespread pain, with no significant differences in any questionnaire-derived or algometry-assessed pain measures between patients with AS and nr-axSpA. Lower pain tolerance was associated with longer symptom duration, worse Ankylosing Spondylitis Disease Activity Score using C-reactive protein (ASDAS-CRP), Bath Ankylosing Spondylitis Functional Index, and Bath Ankylosing Spondylitis Metrology Index (BASMI), more pain regions, unacceptable pain, worse Maastricht AS Enthesitis Score (MASES), fatigue, anxiety, and health-related quality of life. Further, lower pain threshold was associated with worse ASDAS-CRP and MASES, whereas higher temporal summation was associated with longer symptom duration, unacceptable pain, and worse BASMI. CONCLUSION:Chronic pain is common in axSpA, with no observed differences in any pain measures between patients with AS and nr-axSpA. Further, higher pain sensitivity is associated with having worse disease and health outcomes. The results indicate that patients with AS and nr-axSpA, in line with most clinical characteristics, have a similar pain burden, and they highlight large unmet needs regarding individualized pain management, regardless of axSpA subgroup.
Authors: Walter P Maksymowych; Mikkel Østergaard; Robert Landewé; William Barchuk; Ke Liu; Leen Gilles; Thijs Hendrikx; Robin Besuyen; Xenofon Baraliakos Journal: Rheumatology (Oxford) Date: 2022-05-30 Impact factor: 7.046