Neuropathic pain in rheumatoid arthritis
https://doi.org/10.14412/2074-2711-2020-5-60-65
Abstract
Objective: to identify the signs of neuropathic pain (NP) in patients with rheumatoid arthritis (RA) on the basis of the PainDETECT questionnaire and neurological examination.
Patients and methods. A total of 208 RA patients (39 men and 169 women; mean age, 47.7 years) with chronic pain syndrome were examined. The patients underwent rheumatological and neurological examinations; NP was diagnosed using the PainDETECT questionnaire; inflammation severity (DAS28 index), pain intensity (VAS), affective disorders (HADS), and quality of life (EQ-5D) were assessed.
Results and discussion. 172 (82.7%) patients had moderate and high disease activity according to the DAS28. The signs of possible and highly probable NP according to the PainDETECT questionnaire were detected in 29.8 and 26.9% of patients, respectively; they were significantly more likely to be detected in patients with more severe pain syndrome, clinically significant anxiety, and worse quality of life, but were unassociated with RA activity according to the DAS28. Somatosensory nervous system injury (polyneuropathy, tunnel syndromes, and cervical myelopathy) was found in 77.6% of patients with possible NP and in 80.4% with highly probable NP. In other patients, NP might be caused by central sensitization.
Conclusion. In patients with a RA exacerbation, chronic pain syndrome is caused not only by an active inflammatory process in the joint area and adjacent tissues, but also by somatosensory nervous system injury and central sensitization.
About the Authors
E. S. Filatova
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Ekaterina S. Filatova
34A, Kashirskoe Shosse, Moscow 115522
A. M. Lila
V.A. Nasonova Research Institute of Rheumatology;
Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Russian Federation
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522,
2/1, Barrikadnaya St., Build. 1, Moscow 125993
V. A. Parfenov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
Russian Federation
11, Rossolimo St., Build. 1, Moscow 119021
References
1. Nasonov EL, Karateev DE, Balabanova RM. Rheumatoid arthritis. In: Nasonov EL, Nasonova VA, editors. Revmatologiya. Natsional'noe rukovodstvo [Rheumatology. National Guide]. Moscow: GEOTAR-Media; 2008. P. 290-331 (In Russ.).
2. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016 May 3. doi: 10.1016/S)140-6736(16)30173-7
3. Nasonov EL, editor. Revmatologiya. Rossiyskie klinicheskie rekomendatsii [Rheumatology. Russian Clinical Recommendations]. Moscow: GEOTAR-Media; 2017. P. 17-57 (In Russ.).
4. Koop SMW, ten Klooster PM, Vonkeman HE, et al. Neuropathic-like pain features and cross-sectional associations in rheumatoid arthritis. Arthritis Res Ther. 2015 Sep 3;17(1):237. doi: 10.1186/s13075-015-0761-8
5. Lee YC. Effect and treatment of chronic pain in inflammatory arthritis. Curr Rheumatol Rep. 2013 Jan;15(1):300. doi: 10.1007/s11926-012-0300-4
6. Filatova ES, Turovskaya EF, Alekseeva LI, et al. Analysis of the pathogenetic mechanisms of chronic joint pain in patients with rheumatoid arthritis and knee osteoarthritis. Nauchnoprakticheskaya revmatologiya = Rheumatology Science and Practice. 2014;52(6):631-5. doi: 10.14412/1995-4484-2014-631-635 (In Russ.).
7. Good AF, Christopher RP, Koepke GH, et al. Peripheral neuropathy associated with rheumatoid arthritis: a clinical and electrodiagnostic study of 70 consecutive rheumatoid arthritis patients. Ann Intern Med. 1956;63:87- 99. doi: 10.7326/0003-4819-63-1-87
8. Ahmed S, Magan T, Vargas M, et al. Use of the PainDETECT tool in rheumatoid arthritis suggests neuropathic and sensitization components in pain reporting. J Pain Res. 2014 Oct 14;7:579-88. doi: 10.2147/JPR.S69011. eCollection 2014.
9. Meirinhos T, Aguiar R, Ambrosio C, Barcelos A. Neuropathic pain in rheumatic diseases: a cross-sectional study. Ann Rheum Dis. 2014;73:A76. doi: 10.1136/annrheumdis-2013-205124.174
10. Perrot S, Dieude P, Perocheau D, Allanore Y. Comparison of pain, pain burden, coping strategies, and attitudes between patients with systemic sclerosis and patients with rheumatoid arthritis: a cross-sectional study. Pain Med. 2013 Nov;14(11):1776-85. doi: 10.1111/pme.12213. Epub 2013 Jul 30.
11. Hochman JR, French MR, Bermingham SL, Hawker GA. The nerve of osteoarthritis pain. Arthritis Care Res (Hoboken). 2010 Jul;62(7):1019-23. doi: 10.1002/acr.20142
12. Hochman JR, Gagliese L, Davis AM, Hawker GA. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthr Cartil. 2011 Jun;19(6):647-54. doi: 10.1016/j.joca.2011.03.007. Epub 2011 Apr 8.
13. Oteo-Alvaro A, Ruiz-Iban MA, Miguens X, et al. High prevalence of neuropathic pain features in patients with knee osteoarthritis: a cross-sectional study. Pain Pract. 2015 Sep;15(7):618-26. doi: 10.1111/papr.12220. Epub 2014 Apr 21.
14. Askin A, Özkan A, Tosun A, et al. Quality of life and functional capacity are adversely affected in osteoarthritis patients with neuropathic pain. Kaohsiung J Med Sci. 2017 Mar;33(3):152-8. doi: 10.1016/j.kjms.2016.12.007
15. Kim TW, Son SM, Lee JS. Neuropathic pain in ankylosing spondylitis: a meta-analysis. Z Rheumatol. 2020 Feb;79(1):95-102. doi: 10.1007/s00393-019-0654-3
16. Gok K, Cengiz G, Erol K, Ozgocmen S. Neuropathic Pain Component in Axial Spondyloarthritis and the Influence on Disease Burden. J Clin Rheumatol. 2018 Sep;24(6):324- 7. doi: 10.1097/RHU.0000000000000711
17. Amris K, Jespersen A, Bliddal H. Selfreported somatosensory symptoms of neuropathic pain in fibromyalgia and chronic widespread pain correlate with tender point count and pressure-pain thresholds. Pain. 2010 Dec;151(3):664-9. doi: 10.1016/j.pain.2010.08.023. Epub 2010 Sep 15.
18. Rehm S, Koroschetz J, Gockel U. A cross-sectional survey of 3035 patients with fibromyalgia: subgroups of patients with typical comorbidities and sensory symptom profiles. Rheumatology (Oxford). 2010 Jun;49(6):1146- 52. doi: 10.1093/rheumatology/keq066. Epub 2010 Mar 17.
19. Haanpaa M, Attal N, Backonja M, et al. NeuPSIG guidelines on neuropathic pain assessment. Pain. 2011 Jan;152(1):14-27. doi: 10.1016/j.pain.2010.07.031. Epub 2010 Sep 19.
20. Lee YC, Cui J, Lu B, et al. Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: a longitudinal observational study. Arthritis Res Ther. 2011 Jun 8;13(3):R83. doi: 10.1186/ar3353
21. Lanzillo B, Psappone N, Criscil C, et al. Subclinical peripheral nerve involvement in patients with rheumatoid arthritis. Arthritis Rheum. 1998;41:1196-202. doi: 10.1002/1529-0131(199807)41:73.0.CO;2-R
22. Nadkar MY, Agarwal R, Samant RS, et al. Neuropathy in rheumatoid arthritis. J Assoc Physicians India. 2001 Feb;49:217-20.
23. Bayrak AO, Durmus D, Durmaz Y, et al. Electrophysiological assessment of polyneuropathic involvement in rheumatoid arthritis: relationship among demoraphic, clinical and laboratory findings. Neurol Res. 2010;32:711-4. doi: 10.1179/016164109x12581096870195
24. Ramos-Remus C, Duran-Barragan S, Castillo-Ortiz JD. Beyond the joints. Neurological involvment in rheumatoid arthritis. Clin Rheumatol. 2012 Jan;31(1):1-12. doi: 10.1007/s10067-011-1841-z. Epub 2011 Sep 20.
25. Agarwal V, Singht R, Wiclaf, et al. A clinical, electrophysiological, and pathological study of neuropathy in rheumatoid arthritis. Clin Rheumatol. 2008 Jul;27(7):841-4. doi: 10.1007/s10067-007-0804-x. Epub 2007 Dec 15.
26. Muramatsu K, Tanaka H, Taguchi T Peripheral neuropathis of the forearm and hand in rheumatoid arthritis: diagnosis and options for treatment. Rheumatol Int. 2008 Aug;28(10):951-7. doi: 10.1007/s00296-008-0630-8. Epub 2008 Jun 6.
27. Davydov OS, Yakhno NN, Kukushkin ML, et al. Nevropaticheskaya bol'. Klinicheskiye rekomendatsii po diagnostike i lecheniyu [Neuropathic pain. Clinical guidelines for diagnosis and treatment]. AMI «Medforum»; 2018. P. 1-82 (In Russ.).
28. Abrahams MJ. Neuropathic pain in soft tissue complaints. Best Pract Res Clin Rheumatol. 2007 Apr;21(2):223-44. doi: 10.1016/j.berh.2006.12.005
29. Bliddal H, Danneskiold-Samsoe B. Chronic widespread pain in the spectrum of rheumatological diseases. Best Pract Res Clin Rheumatol. 2007 Jun;21(3):391-402. doi: 10.1016/j.berh.2007.03.005
30. Hochman JR, Davis AM, Elkayam J, et al. Neuropathic pain symptoms on the modified PainDETECT correlate with signs of central sensitization in knee osteoarthritis. Osteoarthritis Cartilage. 2013 Sep;21(9):1236-42. doi: 10.1016/j.joca.2013.06.023
31. Soni A, Batra RN, Gwilym SE, et al. Neuropathic features of joint pain: a community-based study. Arthritis Rheum. 2013 Jul;65(7):1942-9. doi: 10.1002/art.37962
32. Filatova ES, Erdes ShF. Etiopathogenetic factors of peripheral neuropathic pain in rheumatoid arthritis. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2017;117(8):67-71. doi: 10.17116/jnevro20171178167-71 (In Russ.).
33. Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014 Apr 16;311(15):1547-55. doi: 10.1001/jama.2014.3266
Review
For citations:
Filatova ES, Lila AM, Parfenov VA. Neuropathic pain in rheumatoid arthritis. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(5):60-65. (In Russ.) https://doi.org/10.14412/2074-2711-2020-5-60-65
Views:
1281
Email this article 