Zoe Rutter-Locher, Sam Norton, Bina Menon, Tom Esterine, Ruth Williams, Leonie S Taams, Bruce W Kirkham, Kirsty Bannister
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引用次数: 0
Abstract
Abstract: Patients with inflammatory arthritis (IA) often report pain not necessarily coupled to active inflammation. We previously demonstrated that a significant subset of patients with newly diagnosed IA report features of centrally mediated pain. In this prospective study following the same IA cohort, we tracked the relative contributions of inflammatory/noninflammatory mechanisms to pain over 2 years. We used patient-reported outcome measures (PROMs), clinical data (including ultrasound), and standardised quantitative sensory testing. Mixed-effects regression models examined longitudinal associations. We recruited 66 patients. At 6, 12, and 24 months, 62%, 57%, and 49% of individuals, respectively, reported persistent pain (numerical rating scale ≥3). Using factor-derived composite scores, baseline and longitudinal inflammation was not associated with subsequent pain ( b -0.05, P = 0.87), whereas higher centrally mediated pain markers predicted less pain reduction ( b 1.41, 95%, P < 0.001). Baseline PROMs of centrally mediated pain (fibromyalgia severity average marginal effect [AME]: 0.94, P < 0.001, painDETECT AME: 1.03, P < 0.001) and mental health (eg, Generalised Anxiety Disorder-7 AME: 1.08, P < 0.001) were the strongest predictors of persistent pain. Baseline trapezius pressure pain threshold (PPT) and conditioned pain modulation (CPM) pain detection threshold (PDT) effect showed modest association (trapezius PPT AME: -0.51, P = 0.054, CPM PDT effect AME: -0.49, P = 0.051) whereas temporal summation of pain (AME: 0.09, P = 0.756) and CPM pain tolerance threshold effect (AME: -0.01, P = 0.964) did not. In our cohort, persistent pain was associated with higher baseline and longitudinal scores for centrally mediated pain according to PROMs rather than inflammation according to joint ultrasound. In IA, early identification and treatment of features of centrally mediated pain may improve pain-related outcomes.
摘要：炎症性关节炎（IA）患者经常报告疼痛，但不一定伴有活动性炎症。我们之前证明，新诊断的IA患者中有很大一部分报告了中枢介导性疼痛的特征。在这项前瞻性研究中，我们追踪了2年来炎症/非炎症机制对疼痛的相对影响。我们使用了患者报告的结果测量（PROMs）、临床数据（包括超声）和标准化的定量感觉测试。混合效应回归模型检验了纵向关联。我们招募了66名患者。在6、12和24个月时，分别有62%、57%和49%的个体报告持续疼痛（数值评定量表≥3）。使用因子衍生的综合评分，基线和纵向炎症与随后的疼痛无关（b -0.05, P = 0.87），而较高的中枢介导的疼痛标志物预测疼痛减轻较少（b 1.41, 95%, P < 0.001）。中枢介导性疼痛（纤维肌痛严重程度平均边际效应[AME]: 0.94, P < 0.001, painDETECT AME: 1.03, P < 0.001）和心理健康（如广泛性焦虑障碍-7 AME: 1.08, P < 0.001）的基线PROMs是持续疼痛的最强预测因子。基线斜方肌压力疼痛阈值（PPT）与条条性疼痛调节（CPM）疼痛检测阈值（PDT）效应存在适度关联（斜方肌PPT效应AME: -0.51, P = 0.054， CPM PDT效应AME: -0.49, P = 0.051），而疼痛时间累加效应（AME: 0.09, P = 0.756）和CPM疼痛耐受阈值效应（AME: -0.01, P = 0.964）无相关性。在我们的队列中，根据PROMs，持续疼痛与较高的基线和纵向评分相关，而不是与关节超声显示的炎症相关。在IA中，早期识别和治疗中枢介导性疼痛的特征可以改善疼痛相关的预后。
期刊介绍：
PAIN® is the official publication of the International Association for the Study of Pain and publishes original research on the nature,mechanisms and treatment of pain.PAIN® provides a forum for the dissemination of research in the basic and clinical sciences of multidisciplinary interest.
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