Nöropatik ağrı aksiyal spondiloartritte gözden kaçan bir semptom mu?

Amaç: Aksiyal spondiloartitler (axSpA) kronik inflamatuar romatolojik hastalıklardan olup ağrı yaşam kalitelerini etkileyen en sık semptomdur. Literatürde ağrının her zaman inflamasyonla korele olmadığı gösterilmiştir. Bu çalışma ile aksiyal spondiloartrit hastalarında nöropatik ağrının frekansının gösterilmesi ve nöropatik ağrı ile hasta özelliklerinin arasındaki ilişkinin gösterilmesi amaçlanmıştır. Gereç ve Yöntem: Kliniğimizde Ocak- Mart 2019 ayları arasında takip edilen, Assessment of SpondyloArthritis International Society klasifikasyon kriterlerine göre axSpA kabul edilen hastalar çalışmaya dahil edilmiştir. Nöropatik ağrı Douleur Neuropathique en 4 Questions (DN4) ölçeği ile değerlendirildi. Bulgular: Seksen yedi axSpa hastası çalışmaya dahil edildi. Hastaların 30’unda DN4 ölçeğine göre (DN4 >4) nöropatik ağrı var kabul edildi. Nöropatik ağrı aktif hasta grubunda (ASDAS- CRP ve BASDAI’ ye göre) daha fazla saptandı. DN4 skoru ASDAS- CRP ve BASDAI skoru ile orta düzeyde korele saptandı. Hasta eğitim düzeyi ile DN4 skoru arasında hafif düzeyde korelasyon saptandı. Sonuç: Çalışmamızda axSpA hastalarında inflamatuvar ağrıya ek olarak nöropatik ağrının görülebileceği ve hastalık aktivitesi ile korele olabileceği gösterildi. Nöropatik ağrı hastaların yaşam kalitesini bozduğu, sosyal ve emosyonel bozukluklara yol açtığı literatürde gösterilmiştir. Hastalar standart anti inflamatuvar tedavi yaklaşımlarından fayda görmeyebilir. AxSpA hastalarında nöropatik ağrının değerlendirilmesi önem kazanmaktadır. AxSpA hastalarında nöropatik ağrının tanı ve tedavi sürecinde ileri çalışmalara gereksinim duyulmaktadır.

Is neuropathic pain an overlooked symptom in axial spondyloarthritis?

Purpose: Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatologic disease. Pain is the most common symptom affecting quality of life in axSpA patients. It has been showed that pain is not always correlated with inflammation in patients. The aim of our study was to investigate the frequency of neuropathic pain in axSpA patients and relationship between neuropathic pain and patient characteristics. Materials and Methods: Patients diagnosed as axSpA according to the Assessment of SpondyloArthritis International Society classification criteria, who presented in our outpatients clinics from January to March 2019 were included in this study. The neuropathic component of pain was evaluated with Douleur Neuropathique en 4 Questions (DN4) questionnaire. Results: Eighty seven axSpA patients were included in the study. Thirty of patients had neuropathic pain according to DN4 questionnaire (DN4>4). Neuropathic pain was higher in active disease group depending on both of ASDAS-CRP and BASDAI. DN4 score of patients was found moderately correlated with ASDAS-CRP and BASDAI score. A weak positive correlation was found between patients education level and DN4 score. Conclusion: We showed that neuropathic pain could be seen in patients with axSpA and it could be correlated with disease activity. The studies have proven that neuropathic pain could lead to impaired quality of life and social & emotional functions. Patients with neuropathic pain could not benefit from antiinflammatory treatments. Therefore evaluating of neuropathic pain is important in axSpA patients. Further studies on management of neuropathic pain in axSpA patients are needed.

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