类风湿关节炎患者在常规合成抗风湿药物治疗失败后的临床表现特征取决于中枢致敏的迹象

A. S. Potapova, A. Karateev, E. Polishchuk, E. V. Matyanova, T. S. Panevin, A. Semashko, A. O. Bobkova, A. R. Khalmetova, E. Filatova, V. N. Amirjanova, A. Lila
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The study group included 509 patients diagnosed with RA (according to ACR/EULAR classification criteria, 2010) with moderate or high disease activity (DAS28-CRP≥3.2) and ineffectiveness or intolerance of conventional synthetic DMARDs, biological DMARDs and JAK inhibitors. Disease activity in patient with RA was assessed by DAS28-CRP. Our study did not include an examination by a neurologist to detect signs of CS, so the Central Sensitization Inventory (CSI) (part one) was used. The BPI questionnaire was used for assessing clinical pain intensity. The PainDETECT, FSS, FIRST, HAQ questionnaires were used for screening neuropathic pain symptoms (NPS), fatigue, fibromyalgia signs and functional impairment, respectively. The HADS questionnaire was recommended for early diagnosis anxiety and depression disorders.Results. Signs of CS (CSI≥40), with a median of 42 [32; 53], were found in 57.2% of the examined patient. Patients with signs of CS were established to have poorer health measure (PGA – 64.6±13.5 and 53.5±16.8; p=0.001), higher pain intensity in all BPI scales, longer morning stiffness – 90 [30; 180] and 60 [20; 120] minutes (p=0.001), more painful joints – 8 [5; 12] and 7 [4; 10] (p=0.005), worse functional status in HAQ (1.65±0.7 and 1.08±0.5; p=0.001) and higher disease activity in DAS28-CRP (4.9±1.0 and 4.6±0.9; p=0.001) compared to patients without signs of CS. There was also direct correlation between CS and a high frequency of having an NPS (PainDETECT>18) – 34.5% and 10.3% (p=0.001), significant anxiety and depression (HADS>11) – 29,0% and 5.1% (p=0.001) and 26.3% and 4.2% (p=0.001) respectively, fatigue (FSS) – 96.5% and 70.4% (p=0.001), signs of fibromyalgia (FIRST≥5) – 38.4% and 6.1% (p=0.001).Conclusion. 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引用次数: 1

摘要

中枢致敏(CS)是一种以伤害性神经元的神经可塑性改变、阈下传入输入、疼痛超敏和发展为广泛性疼痛为特征的疾病。CS可引起对改善疾病的抗风湿药物(DMARDs)反应不足。目的:评价抗风湿治疗无效的RA患者的临床表现特征,是否存在CS的迹象。材料和方法。研究组纳入509例诊断为RA的患者(根据ACR/EULAR分类标准,2010年),疾病活动性中等或较高(DAS28-CRP≥3.2),常规合成dmard、生物dmard和JAK抑制剂无效或不耐受。采用DAS28-CRP评估RA患者的疾病活动性。我们的研究没有包括神经科医生检查CS的迹象,因此使用了中枢致敏量表(CSI)(第一部分)。采用BPI问卷评估临床疼痛强度。采用PainDETECT、FSS、FIRST、HAQ问卷分别筛查神经性疼痛症状(NPS)、疲劳、纤维肌痛体征和功能障碍。HADS问卷被推荐用于焦虑和抑郁障碍的早期诊断。CS的体征(CSI≥40),中位数为42 [32;[53],在57.2%的被检查患者中发现。有CS体征的患者健康指标较差(PGA分别为64.6±13.5和53.5±16.8;p=0.001),所有BPI量表的疼痛强度较高,晨僵时间较长- 90 [30;180]和60 [20];120分钟(p=0.001),更痛的关节- 8 [5;12]和7 [4;10] (p=0.005), HAQ功能状态较差(1.65±0.7和1.08±0.5;p=0.001), DAS28-CRP的疾病活动性增高(4.9±1.0和4.6±0.9;p=0.001)。CS与NPS (PainDETECT>18)的高发生率分别为34.5%和10.3% (p=0.001),显著焦虑和抑郁(HADS>11)分别为29.0%和5.1% (p=0.001)和26.3%和4.2% (p=0.001),疲劳(FSS)分别为96.5%和70.4% (p=0.001),纤维肌痛体征(FIRST≥5)分别为38.4%和6.1% (p=0.001)。RA患者CS症状的出现显著增强了许多疾病症状,与更高的疼痛强度、疲劳、功能受损、更高的NPS发生率、抑郁和焦虑以及纤维肌痛相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Features of clinical manifestations of rheumatoid arthritis in patients after failure of conventional synthetic disease-modifying antirheumatic drugs therapy depending on the signs of central sensitization
Central sensitization (CS) is a condition characterised by (associated with) neuroplastic changes in nociceptive neurons, sub-threshold afferent input, pain hypersensitivity and development widespread pain. Insufficient response to disease-modifying antirheumatic drugs (DMARDs) can be caused by CS.Objective – to evaluate the features of clinical manifestations of RA in patients with ineffective antirheumatic therapy, depending on the presence of signs of CS.Material and methods. The study group included 509 patients diagnosed with RA (according to ACR/EULAR classification criteria, 2010) with moderate or high disease activity (DAS28-CRP≥3.2) and ineffectiveness or intolerance of conventional synthetic DMARDs, biological DMARDs and JAK inhibitors. Disease activity in patient with RA was assessed by DAS28-CRP. Our study did not include an examination by a neurologist to detect signs of CS, so the Central Sensitization Inventory (CSI) (part one) was used. The BPI questionnaire was used for assessing clinical pain intensity. The PainDETECT, FSS, FIRST, HAQ questionnaires were used for screening neuropathic pain symptoms (NPS), fatigue, fibromyalgia signs and functional impairment, respectively. The HADS questionnaire was recommended for early diagnosis anxiety and depression disorders.Results. Signs of CS (CSI≥40), with a median of 42 [32; 53], were found in 57.2% of the examined patient. Patients with signs of CS were established to have poorer health measure (PGA – 64.6±13.5 and 53.5±16.8; p=0.001), higher pain intensity in all BPI scales, longer morning stiffness – 90 [30; 180] and 60 [20; 120] minutes (p=0.001), more painful joints – 8 [5; 12] and 7 [4; 10] (p=0.005), worse functional status in HAQ (1.65±0.7 and 1.08±0.5; p=0.001) and higher disease activity in DAS28-CRP (4.9±1.0 and 4.6±0.9; p=0.001) compared to patients without signs of CS. There was also direct correlation between CS and a high frequency of having an NPS (PainDETECT>18) – 34.5% and 10.3% (p=0.001), significant anxiety and depression (HADS>11) – 29,0% and 5.1% (p=0.001) and 26.3% and 4.2% (p=0.001) respectively, fatigue (FSS) – 96.5% and 70.4% (p=0.001), signs of fibromyalgia (FIRST≥5) – 38.4% and 6.1% (p=0.001).Conclusion. The presence of signs of CS in patient with RA significantly enhance many symptoms of disease, being associated with higher pain intensity, fatigue, impaired function, higher incidence of NPS, depression and anxiety, and fibromyalgia.
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