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Current Rheumatology Reviews


ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Research Article

Central Sensitization in Spondyloarthritis: The Crossroads between Disease Activity, Health-related Quality of Life and Fibromyalgia

Author(s): Ben Tekaya Aicha, Cherif Ines*, Saidane Olfa, Bouden Selma, Rouached Leila, Tekaya Rawdha, Mahmoud Ines and Abdelmoula Leila

Volume 19, Issue 4, 2023

Published on: 17 May, 2023

Page: [479 - 487] Pages: 9

DOI: 10.2174/1573397119666230327115316

Price: $65


Objective: To assess central sensitization in young patients with spondyloarthritis (SpA) and to study the associated factors with higher central sensitization scores.

Methods: This was a cross-sectional study including patients with SpA (ASAS criteria) aged less than 50 years. For all patients, we collected the sociodemographic and disease characteristics data. Central sensitization was assessed using a validated tool: The Central Sensitization inventory (CSI). Pain status, fibromyalgia, quality of life, anxiety and depression were screened by the Brief pain inventory, the Fibromyalgia rapid screening tool (FiRST), the ASQoL, and the Hospital anxiety and depression scale (HAD) anxiety and depression. Univariable and multivariable linear regression analyses were performed to achieve our objective.

Results: Seventy-two patients were enrolled (65,2% males). The median age was 39 (28,25-46) years. Median BASDAI and ASDAS-CRP scores were 3 (2.1 - 4.7) and 2.7 (1.9 - 3.48), respectively. The median value of the CSI score was 15 (6,25-33,75); a CSI≥40 was noted in 15.3% of patients. Depression, anxiety scores, fibromyalgia and impaired QoL were screened in 11%, 9,7%, 9,7%, and 44,4%, respectively. CSI≥40 was positively correlated with ASQoL, FiRST, HAD anxiety, HAD depression and the 5 categories of pain interference (mood, regular work, relationships, sleep and enjoyment of life). Multivariate analysis identified a predictive model which included the combination of FiRST, BASDAI and ASQoL. First was the strongest predictive factor of a higher central sensitization.

Conclusion: CS is frequent among SpA patients and should be looked for in order to improve QoL.

Keywords: Central nervous system, sensitization, spondyloarthritis, pain, quality, life, fibromyalgia.

Graphical Abstract
Stolwijk C, van Onna M, Boonen A, van Tubergen A. Global Prevalence of spondyloarthritis: A systematic review and meta-regression analysis. Arthritis Care Res 2016; 68(9): 1320-31.
[] [PMID: 26713432]
Strand V, Deodhar A, Alten R, et al. Pain and fatigue in patients with ankylosing spondylitis treated with tumor necrosis factor inhibitors. J Clin Rheumatol 2021; 27(8): e446-55.
[] [PMID: 32826654]
Arends S, Brouwer E, Efde M, et al. Long-term drug survival and clinical effectiveness of etanercept treatment in patients with ankylosing spondylitis in daily clinical practice. Clin Exp Rheumatol 2017; 35(1): 61-8.
[PMID: 27749222]
Macfarlane GJ, Rotariu O, Jones GT, Pathan E, Dean LE. Determining factors related to poor quality of life in patients with axial spondyloarthritis: Results from the British Society for Rheumatology Biologics Register (BSRBR-AS). Ann Rheum Dis 2020; 79(2): 202-8.
[] [PMID: 31662321]
Ji RR, Nackley A, Huh Y, Terrando N, Maixner W. Neuroinflammation and central sensitization in chronic and widespread pain. Anesthesiology 2018; 129(2): 343-66.
[] [PMID: 29462012]
Latremoliere A, Woolf CJ. Central sensitization: A generator of pain hypersensitivity by central neural plasticity. J Pain 2009; 10(9): 895-926.
[] [PMID: 19712899]
Middlebrook N, Rushton AB, Abichandani D, Kuithan P, Heneghan NR, Falla D. Measures of central sensitization and their measurement properties in musculoskeletal trauma: A systematic review. Eur J Pain 2021; 25(1): 71-87.
[] [PMID: 33034137]
Guler MA, Celik OF, Ayhan FF. The important role of central sensitization in chronic musculoskeletal pain seen in different rheumatic diseases. Clin Rheumatol 2020; 39(1): 269-74.
[] [PMID: 31446538]
Kieskamp SC, Paap D, Carbo MJG, et al. Central sensitization has major impact on quality of life in patients with axial spondyloarthritis. Semin Arthritis Rheum 2022; 52: 151933.
[] [PMID: 35033996]
Saitou M, Noda K, Matsushita T, Ukichi T, Kurosaka D. Central sensitisation features are associated with neuropathic pain-like symptoms in patients with longstanding rheumatoid arthritis: A cross-sectional study using the central sensitisation inventory. Clin Exp Rheumatol 2021; 40(5): 980-7.
[] [PMID: 34128802]
Trouvin AP, Attal N, Perrot S. Assessing central sensitization with quantitative sensory testing in inflammatory rheumatic diseases: A systematic review. Joint Bone Spine 2022; 89(5): 105399.
[] [PMID: 35504515]
Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis 2009; 68(6): 777-83.
[] [PMID: 19297344]
Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70(1): 25-31.
[] [PMID: 21109520]
Alkan H, Yildiz N, Ardiç F. The correlations between disease specific quality of life, short form-36 and clinical variables in patients with ankylosing spondylitis. Arch Rheumatol 2020; 35(4): 468-76.
[] [PMID: 33758803]
Mayer TG, Neblett R, Cohen H, et al. The development and psychometric validation of the central sensitization inventory. Pain Pract 2012; 12(4): 276-85.
[] [PMID: 21951710]
Neblett R, Cohen H, Choi Y, et al. The Central Sensitization Inventory (CSI): Establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain 2013; 14(5): 438-45.
[] [PMID: 23490634]
Madi M, Hamzeh H, Abujaber S, Altubasi I. Cross cultural adaptation, validity, and reliability of central sensitization inventory in arabic language. Disabil Rehabil 2022; 44(25): 8075-83.
[] [PMID: 34813384]
Neblett R, Hartzell MM, Mayer TG, Cohen H, Gatchel RJ. Establishing clinically relevant severity levels for the central sensitization inventory. Pain Pract 2017; 17(2): 166-75.
[] [PMID: 26989894]
Chatila N, Pereira B, Maarrawi J, Dallel R. Validation of a new arabic version of the neuropathic pain diagnostic questionnaire (DN4). Pain Pract 2017; 17(1): 78-87.
[] [PMID: 26895970]
Terkawi A, Tsang S, AlKahtani G, et al. Development and validation of Arabic version of the Hospital Anxiety and Depression Scale. Saudi J Anaesth 2017; 11(5) (Suppl. 1): 11.
[] [PMID: 28616000]
Perrot S, Bouhassira D, Fermanian J. Development and validation of the Fibromyalgia Rapid Screening Tool (FiRST). Pain 2010; 150(2): 250-6.
[] [PMID: 20488620]
Meeus M, Vervisch S, De Clerck LS, Moorkens G, Hans G, Nijs J. Central sensitization in patients with rheumatoid arthritis: A systematic literature review. Semin Arthritis Rheum 2012; 41(4): 556-67.
[] [PMID: 22035625]
ten Klooster PM, de Graaf N, Vonkeman HE. Association between pain phenotype and disease activity in rheumatoid arthritis patients: A non-interventional, longitudinal cohort study. Arthritis Res Ther 2019; 21(1): 257.
[] [PMID: 31783899]
Schaible HG, Grubb BD. Afferent and spinal mechanisms of joint pain. Pain 1993; 55(1): 5-54.
[] [PMID: 8278210]
Pathan EMI, Inman RD. Pain in spondyloarthritis: A neuro-immune interaction. Best Pract Res Clin Rheumatol 2017; 31(6): 830-45.
[] [PMID: 30509443]
Yücel FN, Duruöz MT. Central Sensıtızatıon In Axıal Spondyloarthrıtıs: An exploratıve study wıth quantıtatıve sensory testıng and clınıcal scales. Mod Rheumatol 2022; 32(6): 1137-45.
[] [PMID: 34865130]
Kieskamp SC, Paap D, Carbo MJG, et al. Central sensitization, illness perception and obesity should be considered when interpreting disease activity in axial spondyloarthritis. Rheumatology 2021; 60(10): 4476-85.
[] [PMID: 33492397]
Aykurt Karlıbel I, Kasapoğlu Aksoy M. The relationship between central sensitization and disease activity, quality of life, and sleep quality among Patients with Axial Spondyloarthritis. Ir J Med Sci 2023; 192(1): 481-9.
[] [PMID: 35226249]
Arendt-Nielsen L. Central sensitization in humans: Assessment and pharmacology. Handb Exp Pharmacol 2015; 227: 79-102.
[] [PMID: 25846615]
Yunus MB. Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain. Best Pract Res Clin Rheumatol 2007; 21(3): 481-97.
[] [PMID: 17602995]
Robinson JP, Theodore BR, Wilson HD, Waldo PG, Turk DC. Determination of fibromyalgia syndrome after whiplash injuries: Methodologic issues. Pain 2011; 152(6): 1311-6.
[] [PMID: 21419574]
Robinson ME, Craggs JG, Price DD, Perlstein WM, Staud R. Gray matter volumes of pain-related brain areas are decreased in fibromyalgia syndrome. J Pain 2011; 12(4): 436-43.
[] [PMID: 21146463]
Atzeni F, Boccassini L, Di Franco M, et al. Chronic widespread pain in spondyloarthritis. Reumatismo 2014; 66(1): 28-32.
[] [PMID: 24938193]
Heikkilä S, Ronni S, Kautiainen HJ, Kauppi MJ. Functional impairment in spondyloarthropathy and fibromyalgia. J Rheumatol 2002; 29(7): 1415-9.
[PMID: 12136899]
Aloush V, Ablin JN, Reitblat T, Caspi D, Elkayam O. Fibromyalgia in women with ankylosing spondylitis. Rheumatol Int 2007; 27(9): 865-8.
[] [PMID: 17476510]
Bennett EE, Walsh KM, Thompson NR, Krishnaney AA. Central sensitization inventory as a predictor of worse quality of life measures and increased length of stay following spinal fusion. World Neurosurg 2017; 104: 594-600.
[] [PMID: 28479522]
Kregel J, Schumacher C, Dolphens M, et al. Convergent validity of the dutch central sensitization inventory: Associations with psychophysical pain measures, quality of life, disability, and pain cognitions in patients with chronic spinal pain. Pain Pract 2018; 18(6): 777-87.
[] [PMID: 29222851]
Eller-Smith OC, Nicol AL, Christianson JA. Potential mechanisms underlying centralized pain and emerging therapeutic interventions. Front Cell Neurosci 2018; 12: 35.
[] [PMID: 29487504]
Mease PJ. Fibromyalgia, a missed comorbidity in spondyloarthritis: Prevalence and impact on assessment and treatment. Curr Opin Rheumatol 2017; 29(4): 304-10.
[] [PMID: 28394827]
Zimmermann M. Pathophysiological mechanisms of fibromyalgia. Clin J Pain 1991; 7(1): S8-S15.
[] [PMID: 1810527]
Oye I, Mørland LM, Gustafsson H. Fibromyalgia and central sensitization. Lakartidningen 1996; 93(21): 2040.
[PMID: 8649090]
Jones GT, Mallawaarachchi B, Shim J, Lock J, Macfarlane GJ. The prevalence of fibromyalgia in axial spondyloarthritis. Rheumatol Int 2020; 40(10): 1581-91.
[] [PMID: 32556474]
Clauw DJ, Katz P. The overlap between fibromyalgia and inflammatory rheumatic disease. J Clin Rheumatol 1995; 1(6): 335-42.
[] [PMID: 19078011]
Salaffi F, De Angelis R, Carotti M, Gutierrez M, Sarzi-Puttini P, Atzeni F. Fibromyalgia in patients with axial spondyloarthritis: Epidemiological profile and effect on measures of disease activity. Rheumatol Int 2014; 34(8): 1103-10.
[] [PMID: 24509896]
Bello N, Etcheto A, Béal C, Dougados M, Moltó A. Evaluation of the impact of fibromyalgia in disease activity and treatment effect in spondyloarthritis. Arthritis Res Ther 2016; 18(1): 42.
[] [PMID: 26860612]
Azevedo VF, Paiva E dos S, Felippe LRH, Moreira RA. Occurrence of fibromyalgia in patients with ankylosing spondylitis. Rev Bras Reumatol 2010; 50(6): 646-50.
[] [PMID: 21243305]
Mibu A, Nishigami T, Tanaka K, Manfuku M, Yono S. Difference in the impact of central sensitization on pain-related symptoms between patients with chronic low back pain and knee osteoarthritis. J Pain Res 2019; 12: 1757-65.
[] [PMID: 31213887]
Stearns PN. The history of happiness. Harv Bus Rev 2012; 90(1-2): 104-109, 153.
[PMID: 22299510]
Mogilner C. The pursuit of happiness: Time, money, and social connection. Psychol Sci 2010; 21(9): 1348-54.
[] [PMID: 20732902]
Marangell LB, Clauw DJ, Choy E, et al. Comparative pain and mood effects in patients with comorbid fibromyalgia and major depressive disorder: Secondary analyses of four pooled randomized controlled trials of duloxetine. Pain 2011; 152(1): 31-7.
[] [PMID: 20598442]
Hart FD. Control of pain in the rheumatic disorders. BMJ 1968; 3(5619): 635-40.
[] [PMID: 5302595]
McDonough E, Ayearst R, Eder L, et al. Depression and anxiety in psoriatic disease: Prevalence and associated factors. J Rheumatol 2014; 41(5): 887-96.
[] [PMID: 24692521]
Bagnato G, De Andres I, Sorbara S, et al. Pain threshold and intensity in rheumatic patients: Correlations with the Hamilton Depression Rating scale. Clin Rheumatol 2015; 34(3): 555-61.
[] [PMID: 24407907]
Durmus D, Sarisoy G, Alayli G, et al. Psychiatric symptoms in ankylosing spondylitis: Their relationship with disease activity, functional capacity, pain and fatigue. Compr Psychiatry 2015; 62: 170-7.
[] [PMID: 26343482]
Smart KM, Blake C, Staines A, Doody C. Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with ‘nociceptive’, ‘peripheral neuropathic’ and ‘central sensitisation’ pain. The discriminant validity of mechanisms-based classifications of low back (±leg) pain. Man Ther 2012; 17(2): 119-25.
[] [PMID: 22074733]
Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. Phys Ther 2011; 91(5): 700-11.
[] [PMID: 21451097]
Roussel N, Barbara C, Dolphens M, et al. Sensibilisation Centrale et Modification Du Traitement Central de La Doleur Chez Les Patients Souffrant de Lombalgies (French Version). Ortho - Rheumato 2014; 12: 29-35.
Nguyen JP, Dixneuf V, Esnaut J, et al. The value of high-frequency repetitive transcranial magnetic stimulation of the motor cortex to treat central pain sensitization associated with knee osteoarthritis. Front Neurosci 2019; 13: 388.
[] [PMID: 31057363]
Bannister K, Kucharczyk M, Dickenson AH. Hopes for the Future of Pain Control. Pain Ther 2017; 6(2): 117-28.
[] [PMID: 28536900]
Caumo W, Deitos A, Carvalho S, et al. Motor cortex excitability and BDNF levels in chronic musculoskeletal pain according to structural pathology. Front Hum Neurosci 2016; 10: 357.
[] [PMID: 27471458]

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