Neuropathic pain in spondyloarthritis: Decoding its prevalence, risk factors, and impact on disease activity

• Published in: Seminars in arthritis and rheumatism 2024-12, Vol.69, p.152557, Article 152557
• Main Authors: Lopalco, Giuseppe, Vescovo, Sergio Del, Morrone, Maria, Cito, Andrea, Fornaro, Marco, Capparelli, Eugenio, Cela, Eneida, Chimenti, Maria Sole, Iannone, Florenzo
• Format: Article
• Language: English
• Subjects: Adult; Biologic drugs; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Neuralgia - epidemiology; Neuralgia - etiology; Neuropathic pain; Pain Measurement; Precision medicine; Prevalence; Psoriatic arthritis; Risk Factors; Severity of Illness Index; Spondylarthritis - complications; Spondylarthritis - epidemiology; Spondyloarthritis
• ISSN: 0049-0172; 1532-866X; 1532-866X
• DOI: 10.1016/j.semarthrit.2024.152557

•A significant proportion of spondyloarthritis (SpA) patients exhibits signs of neuropathic pain, as assessed through specialized pain questionnaires.•Female and obese patients report more severe neuropathic pain symptoms compared to other patient groups.•Higher neuropathic pain scores are associated with increased disease activity in SpA patients.•The study highlights the importance of routine neuropathic pain assessment in SpA management to optimize treatment strategies and improve patient care. This study aimed to evaluate the prevalence and characteristics of neuropathic pain in patients with various subtypes of spondyloarthritis (SpA), including axial SpA (axSpA), psoriatic arthritis (PsA), and undifferentiated peripheral SpA (p-SpA). Additionally, the study sought to identify potential risk factors associated with the presence or severity of neuropathic pain and to investigate its impact on clinical disease activity assessment. We conducted a cross-sectional study at two tertiary rheumatology centers, enrolling patients diagnosed with SpA. Data on demographic and clinical characteristics, comorbidities, and current therapies were collected. Neuropathic pain was assessed using the PainDETECT Questionnaire (PD-Q) and the Neuropathic Pain Symptom Inventory (NPSI). Statistical analyses included descriptive statistics, t-tests, and Pearson's correlations to evaluate the relationships between neuropathic pain scores and clinical disease activity indices. The study included 177 patients. Of these, 22.2% had a PD-Q score ≥19, showing a high likelihood of neuropathic pain, while 64.9% scored ≤12, suggesting the absence of significant neuropathic components. The mean PD-Q score was 11.5 ± 10.1. Subgroup analyses showed that females had significantly higher scores for paroxysmal and evoked pain (p < 0.05), and obese patients had significantly higher scores across all NPSI subscores (p < 0.05). Moderate positive correlations were found between neuropathic pain scores and clinical disease activity indices, such as DAPSA (r = 0.46, p < 0.0001) and ASDAS-CRP (r = 0.42, p < 0.01). Neuropathic pain is prevalent among patients with SpA and is significantly associated with disease activity assessments and management. This study highlights the importance of integrating neuropathic pain evaluation into the clinical assessment of SpA to tailor treatment approaches effectively and improve patient outcomes.