Date: Sunday, November 8, 2020
Session Type: Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Up to 40% of ankylosing spondylitis patients report persistently high pain scores of >4 (scale of 0-10) even after responding to long-term TNF-α blocking therapy. In other rheumatic diseases, nociplastic pain (due to altered functioning of the nervous system leading to peripheral and central sensitization) is common. In axial spondyloarthritis (axSpA), patient illness and pain perceptions were shown to influence disease outcome. Therefore, we hypothesized that central sensitization and patients’ illness perceptions are associated with persistently high disease activity in axSpA.
Our objective was to investigate to what extent central sensitization, pain catastrophizing and patients’ perceptions play a role in axSpA and to explore associations with disease activity.
Methods: Between April and September 2019, consecutive outpatients from the Groningen Leeuwarden axSpA (GLAS) cohort, an ongoing large prospective cohort, were included in this study. Besides the standardized assessments, patients filled out three additional questionnaires: Central Sensitization Inventory (CSI), Pain Catastrophizing Scale (PCS) and Revised Illness Perception Questionnaire (IPQ-R). Univariable and multivariable linear regression analyses were used to investigate the association of CSI, PCS and each of the eight subscales of the IPQ-R, and disease activity assessments ASDASCRP, BASDAI, and CRP. We also tested the following patient characteristics: gender, symptom duration, BMI class, educational level, smoking status and HLA-B27 status.
Results: Of 182 included patients, 57% were male, 79% were HLA-B27 positive, median symptom duration was 21 (IQR 10-32), mean ASDASCRP 2.1 ± 1.0, mean BASDAI 3.9 ± 2.2 and median CRP 2.9 (IQR 1.1-7.0). Mean CSI score was 38.0 ± 14.1 (scale of 0-100), and 45% of patients scored ≥40 on the CSI. Median PCS score was 15 (IQR 8-22) (scale of 0-52), median IPQ-R illness identity subscore 3 (IQR 2-4) (scale of 0-14) and median IPQ-R treatment control subscore 18 (IQR 16-20). In univariable regression analysis, CSI, PCS and IPQ-R subscores all showed significant associations with ASDASCRP, and all except the IPQ-R subscale personal control showed significant associations with BASDAI. Only IPQ-R treatment control was significantly associated with CRP. Central sensitization, two IPQ-R subscales (perceived treatment control and the number of symptoms patients attributed to their axSpA: illness identity) and obesity were independently associated with disease activity assessments BASDAI (R2=0.47) and ASDASCRP (R2=0.35) (Figure 1). Only obesity was independently associated with CRP.
Conclusion: In this axSpA population with long-term disease, 45% scored above the CSI cutoff point of 40, indicating a high probability of central sensitization. CSI score, illness identity, perceived treatment control and obesity were independently associated with disease activity assessments ASDASCRP and BASDAI.
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Figure 1. Results of multivariable linear regression analyses for ASDAS and BASDAI. ASDAS: Ankylosing Spondylitis Disease Activity Score; BASDAI: Bath Ankylosing Spondylitis Disease Activity Score; CSI: Central Sensitization Inventory; IPQ-R: Revised Illness Perceptino Questionnaire; BMI: Body Mass Index.
To cite this abstract in AMA style:Kieskamp S, Paap D, Carbo M, Wink F, Bos R, Bootsma H, Arends S, Spoorenberg A. Central Sensitization, Disease Perception and Obesity Should Be Taken into Account When Interpreting Disease Activity in Patients with Axial Spondyloarthritis [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/central-sensitization-disease-perception-and-obesity-should-be-taken-into-account-when-interpreting-disease-activity-in-patients-with-axial-spondyloarthritis/. Accessed October 20, 2021.
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