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. 2022 Aug;41(8):2351-2360.
doi: 10.1007/s10067-022-06185-0. Epub 2022 Apr 30.

Sensory testing and topical capsaicin can characterize patients with rheumatoid arthritis

Bjoern Anders  1 , Malte Anders  2 , Matthias Kreuzer  3 , Sebastian Zinn  4 , Lukas Fricker  2 , Christoph Maier  5 , Miriam Wolters  2 , Michaela Köhm  2   6 , Frank Behrens  2   6 , Carmen Walter  2
Affiliations

Sensory testing and topical capsaicin can characterize patients with rheumatoid arthritis

Bjoern Anders et al. Clin Rheumatol. 2022 Aug.

Abstract

Background and objectives: Our study aimed at examining the long-time inflammatory effects of rheumatoid arthritis (RA) as chronic immune-mediated disease on pain sensation and neuropathy development compared to healthy subjects (HS).

Methods: We used the quantitative sensory testing (QST) protocol of the German Research Network on Neuropathic Pain and Electroencephalography (EEG)-based contact heat evoked potentials (CHEPs) before and after topical capsaicin application. We recruited 16 RA patients in remission or low disease activity state (mean age: 59.38 years [± 10.18]) and 16 healthy subjects (mean age: 56.69 years [± 8.92]).

Results: The application of capsaicin cream on the thigh provoked a stronger effect in HS for both mechanical and heat pain thresholds (MPT and HPT, resp.), according to the area under the receiver operation characteristic (AUROC) (HS: HPT: 0.8965, MPT: 0.7402; RA: HPT: 0.7012, MPT: 0.6113). We observed contrary effects regarding changes in CHEPs (HS: g*max = - 0.65; RA patients: g*max = 0.72).

Conclusion: As the overall effect of topical capsaicin application was higher in HS for QST, we suggest the existence of a sensitization of TRPV1 channels in RA patients caused by long-time chronical inflammation, despite a lack of clinical signs of inflammation due to adequate treatment. The effect in CHEPs probably uncovers neuropathic symptoms. The effect of topical capsaicin on HPTs and CHEPs can act as a marker for the extent of sensitization and the development of neuropathic symptoms. Further studies are needed to prove if our proposed method can act as a marker for the success of anti-inflammatory treatment. Key Points • The effect of topical capsaicin may represent the extent of TRPV1 sensitization in rheumatoid arthritis. • The effect of topical capsaicin on the amplitude level of CHEPs can unmask neuropathic symptoms. • The effect of topical capsaicin on CHEPs and HPTs can show the long-term consequences and the treatment success of RA patients in remission.

Keywords: CHEPs; Capsaicin; Rheumatoid arthritis.

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Figures

Fig. 1
Fig. 1
Boxplot of HPTs (left) and MPTs (right) before vs after capsaicin application in HS and RA patients (red cross = outlier)
Fig. 2
Fig. 2
Average event-related potential (ERP) waveforms from 300 to 700 ms following the 54 °C stimulus before and after the application of capsaicin cream. The lines indicate the average amplitude at Cz electrode location for all subjects of each group. Comparison between the groups was carried out by plotting the Hedges g effect size [g*]. Dots are of white color if p > 0.05 and of black color if p < 0.05
See this image and copyright information in PMC

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