Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 15:13:1759720X21993252.
doi: 10.1177/1759720X21993252. eCollection 2021.

Is central sensitization an important determinant of functional disability in patients with chronic inflammatory arthritides?

Giovanni Adami  1 , Elisabetta Gerratana  2 , Fabiola Atzeni  2 , Camilla Benini  1 , Elisabetta Vantaggiato  1 , Denise Rotta  1 , Luca Idolazzi  1 , Maurizio Rossini  1 , Davide Gatti  1 , Angelo Fassio  3
Affiliations

Is central sensitization an important determinant of functional disability in patients with chronic inflammatory arthritides?

Giovanni Adami et al. Ther Adv Musculoskelet Dis. .

Abstract

Background: Central sensitization (CS) is a condition characterized by a disproportionate response to pain stimuli. We sought to investigate the prevalence of CS in patients with inflammatory arthritides and its association with measures of disease activity and functional disability.

Methods: We conducted an observational retrospective study in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) patients. We administered to all the subjects in the study the CS inventory (CSI), a questionnaire that has been used for the diagnosis of CS. Demographic and clinical characteristics were collected as well as measures or disease activity [i.e. Simple Disease Activity Index, Disease Activity Score in PsA (DAPSA)] and functional disability [Health Assessment Questionnaire Disability Index (HAQ-DI)]. Patients with fibromyalgia were excluded from the analyses. The primary outcome measure was the presence of functional disability as assessed by HAQ-DI >1.

Results: We enrolled 150 patients with inflammatory arthritides (78 PsA and 72 RA). Prevalence of CS was observed in 35.3% of the overall sample (29% in RA, 42.9% in PsA). Binary logistic regressions showed a strong, independent and linear association between functional disability and CS in both PsA and RA patients. The strength of this association was greater in PsA than in RA.

Conclusion: CS is an important determinant of functional disability in patients with chronic inflammatory arthritides. PsA appeared to be more vulnerable to CS. In addition, in the presence of CS, DAPSA did not adequately capture the occurrence of functional disability. Therefore, special attention should be paid to PsA patients, in whom the concomitant diagnosis of CS should be routinely ruled out.

Keywords: biopsychosocial; central sensitization; disability; pain; psoriasis; psoriatic arthritis; rheumatoid arthritis.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement: Angelo Fassio reports personal fees from Abiogen, Novartis, Neopharmed, outside the submitted work. Luca Idolazzi reports personal fees from Eli-Lilly, Merck Sharp & Dohme, Novartis, Sanofi, Celgene, UCB outside the submitted work. Maurizio Rossini reports personal fees from AbbVie, Abiogen, Eli-Lilly, Merck Sharp & Dohme, Novartis, Sanofi, UCB, outside the submitted work. Davide Gatti has received advisory board honoraria, consultancy fees and/or speaker fees from Abiogen, Celgene, Eli-Lilly, Neopharmed-Gentili, Pfizer, UCB. All other authors do not have anything to disclose.

Figures

Figure 1.
Figure 1.
Distribution of the HAQ-DI score according to the different CSI score ranks of the overall cohort. Bars show median and interquartile range. CSI, central sensitization inventory; HAQ-DI, Health Assessment Questionnaire Disability Index.
Figure 2.
Figure 2.
Distribution of the HAQ-DI score according to the different CSI score ranks for the rheumatoid arthritis and psoriatic arthritis subgroups. Bars show median and interquartile range. CSI, central sensitization inventory; HAQ-DI, Health Assessment Questionnaire Disability Index.
See this image and copyright information in PMC

References

    1. Bas DB, Su J, Wigerblad G, et al. Pain in rheumatoid arthritis: models and mechanisms. Pain Manag 2016; 6: 265–284. - PubMed
    1. Sarzi-Puttini P, Salaffi F, Di Franco M, et al. Pain in rheumatoid arthritis: a critical review. Reumatismo 2014; 66: 18–27. - PubMed
    1. Bidad K, Gracey E, Hemington KS, et al. Pain in ankylosing spondylitis: a neuro-immune collaboration. Nat Rev Rheumatol 2017; 13: 410–420. - PubMed
    1. Winthrop KL, Weinblatt ME, Bathon J, et al. Unmet need in rheumatology: reports from the targeted therapies meeting 2019. Ann Rheum Dis 2020; 79: 88–93. - PMC - PubMed
    1. Morris VH, Cruwys SC, Kidd BL. Characterisation of capsaicin-induced mechanical hyperalgesia as a marker for altered nociceptive processing in patients with rheumatoid arthritis. Pain 1997; 71: 179–186. - PubMed

LinkOut - more resources