Chronic widespread pain in spondyloarthritis

• Published in: Reumatismo 2014-06, Vol.66 (1), p.28-32
• Main Authors: Atzeni, F, Boccassini, L, Di Franco, M, Alciati, A, Marsico, A, Cazzola, M, Cassisi, G, Sarzi-Puttini, P
• Format: Article
• Language: English
• Subjects: Analgesics - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antidepressants; Antidepressive Agents - therapeutic use; Antirheumatic Agents - therapeutic use; Arthritis, Psoriatic - diagnosis; Arthritis, Psoriatic - physiopathology; Central Nervous System Sensitization - physiology; Chronic Pain - drug therapy; Chronic Pain - economics; Chronic Pain - etiology; Chronic Pain - physiopathology; Chronic Pain - psychology; Cross-Sectional Studies; Diagnosis, Differential; Fatigue - etiology; Fibromyalgia - diagnosis; Fibromyalgia - physiopathology; Humans; Musculoskeletal Pain - drug therapy; Musculoskeletal Pain - economics; Musculoskeletal Pain - etiology; Musculoskeletal Pain - physiopathology; Musculoskeletal Pain - psychology; Pain; Pain Management; Pain Measurement; Quality of Life; Sleep Disorders, Intrinsic - etiology; Spondylarthritis - diagnosis; Spondylarthritis - drug therapy; Spondylarthritis - economics; Spondylarthritis - physiopathology; Spondyloarthritis, Fibromyalgia, Prevalence, Disease activity, Ankylosing spondylitis disease activity score, Bath ankylosing spondylitis disease activity index; Tumor necrosis factor-TNF
• ISSN: 0048-7449; 2240-2683
• DOI: 10.4081/reumatismo.2014.761

The pain associated with spondyloarthritis (SpA) can be intense, persistent and disabling. It frequently has a multifactorial, simultaneously central and peripheral origin, and may be due to currently active inflammation, or joint damage and tissue destruction arising from a previous inflammatory condition. Inflammatory pain symptoms can be reduced by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in the mechanisms that regulate central pain, as in the case of the chronic widespread pain (CWP) that characterises fibromyalgia (FM). The importance of distinguishing SpA and FM is underlined by the fact that SpA is currently treated with costly drugs such as tumour necrosis factor (TNF) inhibitors, and direct costs are higher in patients with concomitant CWP or FM than in those with FM or SpA alone. Optimal treatment needs to take into account symptoms such as fatigue, mood, sleep, and the overall quality of life, and is based on the use of tricyclic antidepressants or selective serotonin reuptake inhibitors such as fluoxetine, rather than adjustments in the dose of anti-TNF agents or disease-modifying drugs.