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Association Between Pain Sensitization and Disease Activity in Patients With Rheumatoid Arthritis: A Cross‐Sectional Study
Author(s) -
Lee Yvonne C.,
Bingham Clifton O.,
Edwards Robert R.,
Marder Wendy,
Phillips Kristine,
Bolster Marcy B.,
Clauw Daniel J.,
Moreland Larry W.,
Lu Bing,
Wohlfahrt Alyssa,
Zhang Zhi,
Neogi Tuhina
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23266
Subject(s) - medicine , sensitization , rheumatoid arthritis , joint pain , disease , cross sectional study , threshold of pain , cohort , physical therapy , clinical disease , immunology , pathology
Objective Pain sensitization may contribute to pain severity in rheumatoid arthritis ( RA ), impacting disease activity assessment. We examined whether pain processing mechanisms were associated with disease activity among RA patients with active disease. Methods The study included 139 subjects enrolled in the Central Pain in Rheumatoid Arthritis cohort. Subjects underwent quantitative sensory testing ( QST ), including assessment of pressure pain thresholds ( PPT s) at multiple sites, conditioned pain modulation, and temporal summation. RA disease activity was assessed using the Clinical Disease Activity Index ( CDAI ) and its components. We examined cross‐sectional associations between QST measures and disease activity using linear regression. Results Low PPT s (high pain sensitization) at all sites were associated with high CDAI scores ( P ≤ 0.03) and tender joint counts ( P ≤ 0.002). Associations between PPT s and patient global assessments were also seen at most sites. High temporal summation at the forearm (also reflecting high pain sensitization) was significantly associated with high CDAI scores ( P = 0.02), patient global assessment scores ( P = 0.0006), evaluator global assessment scores ( P = 0.01), and tender joint counts ( P = 0.02). Conversely, conditioned pain modulation (a measure of descending inhibitory pain pathways) was associated only with tender joint count ( P = 0.03). Conclusion High pain sensitization is associated with elevations in disease activity measures. Longitudinal studies are underway to elucidate the cause–effect relationships between pain sensitization and inflammatory disease activity in RA .