Duygu GELER-KÜLCÜ, Gülcan ÖZTÜRK, Nilgün MESCİ, Sevilay BATIBAY

The association of neuropathic pain and disease activity, functional level, and quality of life in patients with ankylosing spondylitis: a cross-sectional study

Background/aim: Increased neuropathic pain (NP) symptoms are seen in rheumatologic diseases such as fibromyalgia, osteoarthritis,and rheumatoid arthritis, but no studies have demonstrated a relationship between ankylosing spondylitis (AS) and NP except for abrain imaging study. The aim of this study was to estimate the presence of NP in patients with AS and to investigate how NP was relatedto disease activity, functional status, and quality of life.Materials and methods: A total of 100 AS patients (71 males and 29 females; median age: 37 years, range: 18–71 years) were included inthe study. Pain (visual analog scale (VAS) and the painDETECT questionnaire), disease activity (Bath Ankylosing Spondylitis DiseaseActivity Index (BASDAI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Patient Global Assessment of Disease Activity(PGA), and Ankylosing Spondylitis Disease Activity Score (ASDAS)), functional level (Bath Ankylosing Spondylitis Functional Index(BASFI)), and health-related quality of life (36-Item Short Form Survey (SF-36)) were evaluated. Patients were divided into two groups.Group 1 included patients with possible or likely NP symptoms (painDETECT score of ≥13) and Group 2 included patients without NPsymptoms (painDETECT score of

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Khan MA. Ankylosing spondylitis: introductory comments on its diagnosis and treatment. Ann Rheum Dis 2002; 61: 3-7.
Baron R, Binder A. How neuropathic is sciatica? The mixed pain concept. Orthopade 2004; 33: 568-575.
Freynhagen R, Baron R, Tolle T, Stemmler E, Gockel U, Stevens M, Maier C. Screening of neuropathic pain components in patients with chronic back pain associated with nerve root compression: a prospective observational pilot study (MIPORT). Curr Med Res Opin 2006; 22: 529-537.
Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008; 70: 1630-1635.
Woolf CJ. What is this thing called pain? J Clin Invest 2010; 120: 3742-3744.
Amris K, Jespersen A, Bliddal H. Self-reported somatosensory symptoms of neuropathic pain in fibromyalgia and chronic widespread pain correlate with tender point count and pressure-pain thresholds. Pain 2010; 151: 664-669.
Rehm S, Koroschetz J, Gockel U. A cross-sectional survey of 3035 patients with fibromyalgia: subgroups of patients with typical comorbidities and sensory symptom profiles. Rheumatology 2010; 49: 1146-1152.
Hochman JR, French MR, Bermingham SL, Hawker GA. The nerve of osteoarthritis pain. Arthritis Care Res 2010; 62: 1019- 1023.
Hochman JR, Gagliese L, Davis AM, Hawker GA. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthr Cartil 2011; 19: 647-655.
Ahmed S, Magan T, Vargas M, Harrison A, Sofat N. Use of the painDETECT tool in rheumatoid arthritis suggests neuropathic and sensitization components in pain reporting. J Pain Res 2014; 14: 579-688.
Koop SM, ten Klooster PM, Vonkeman HE, Steunebrink LM, van de Laar MA. Neuropathic-like pain features and crosssectional associations in rheumatoid arthritis. Arthritis Res Ther 2015; 3: 237.
Wu Q, Inman RD, Davis KD. Neuropathic pain in ankylosing spondylitis a psychophysics and brain imaging study. Arthritis Rheum 2013; 65: 1494-1503.
De Vlam K. Soluble and tissue biomarkers in ankylosing spondylitis. Best Pract Res Clin Rheumatol 2010; 24: 671-682.
Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994; 21: 2286-2291.
Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to detect neuropathic components in patients with back pain. Curr Med Res Opin 2006; 22: 1911- 1920.
Gauffin J, Hankama T, Kautiainen H, Hannonen P, Haanpää M. Neuropathic pain and use of painDETECT in patients with fibromyalgia: a cohort study. BMC Neurol 2013; 13: 21.
Morso L, Kent PM, Albert HB. Are self-reported pain characteristics, classified using the painDETECT questionnaire, predictive of outcome in people with low back pain and associated leg pain? Clin J Pain 2011; 27: 535-541.
Hochman JR, Davis AM, Elkayam J, Gagliese L, Hawker GA. Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis. Osteoarthritis Cartilage 2013; 21: 1236-1242.
Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984; 27: 361-368.
Alkan H, Ardic F, Erdogan C, Sahin F, Sarsan A, Findikoglu G. Turkish version of the painDETECT questionnaire in the assessment of neuropathic pain: a validity and reliability study. Pain Med 2013; 14: 1933-1943.
Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N. A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int 2005; 25: 280-284.
Zochling J, Braun J. Assessment of ankylosing spondylitis. Clin Exp Rheumatol 2005; 23: 133-141.
Lukas C, Landewe R, Sieper J, Dougados M, Davis J, Braun J, van der Linden S, van der Heijde D; Assessment of Spondyloarthritis International Society. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 2009; 68: 18-24.
Van der Heijde D, Lie E, Kvien TK, Sieper J, Van den Bosch F, Listing J, Braun J, Landewé R; Assessment of Spondyloarthritis International Society. The ASDAS is a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis 2008; 68: 1811-1818.
Machado P, Landewé R, Lie E, Kvien TK, Braun J, Baker D, van der Heijde D; Assessment of the Spondyloarthritis International Society. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis 2011; 70: 47- 53.
Karatepe AG, Akkoc Y, Akar S, Kirazli Y, Akkoc N. The Turkish versions of The Bath Ankylosing Spondylitis and Dougados Functional Indices: reliability and validity. Rheumatol Int 2005; 25: 612-618.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30: 473-483.
Koçyiğit H, Aydemir Ö, Fişek G, Ölmez N, Memiş A. Reliability and validity of the Turkish version of Short-Form-36 (SF36). İlaç ve Tedavi Dergisi 1999; 12: 102-106 (in Turkish).
Pollard LC, Ibrahim F, Choy EH, Scott DL. Pain thresholds in rheumatoid arthritis: the effect of tender point counts and disease duration. J Rheumatol 2012; 39: 28-31.
Truini A, Padua L, Biasiotta A, Caliandro P, Pazzaglia C, Galeotti F, Inghilleri M, Cruccu G. Differential involvement of A-delta and A-beta fibers in neuropathic pain related to carpal tunnel syndrome. Pain 2009; 145: 105-109.
Garip Y, Eser F, Kılıçarslan A, Bodur H. Prevalence of neuropathic pain in rheumatic disorders: association with disease activity, functional status and quality of life. Arch Rheumatol 2015; 30: 231-237.
Gerbershagen HJ, Rothaug J, Kalkman CJ, Meissner W. Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods. Br J Anaesth 2011; 107: 619-626.
Tubach F, Ravaud P, Martin-Mola E, Awada H, Bellamy N, Bombardier C, Felson DT, Hajjaj‐Hassouni N, Hochberg M, Logeart I et al. Minimum clinically important improvement and patient acceptable symptom state in pain and function in rheumatoid arthritis, ankylosing spondylitis, chronic back pain, hand osteoarthritis, and hip and knee osteoarthritis: results from a prospective multinational study. Arthritis Care Res 2012; 64: 1699-1707.
Lee YC, Cui J, Lu B, Frits ML, Iannaccone CK, Sahdick NA, Weinblatt E, Solomon DH. Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: a longitudinal observational study. Arthritis Res Ther 2011; 13: 83.
Meirinhos T, Aguiar R, Ambrósio C, Barcelos A. Neuropathic pain in rheumatic diseases: a cross-sectional study. Ann Rheum Dis 2014; 73: 76.
Bliddal H, Danneskiold-Samsøe B. Chronic widespread pain in the spectrum of rheumatological diseases. Best Pract Res Clin Rheumatol 2007; 21: 391-402.
Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res 2011; 63: 47-58.
Altan L, Sivrioğlu Y, Ercan İ. Can Bath Ankylosing Spondylitis Disease Activity Index be affected by accompanying fibromyalgia or depression? Arch Rheumatol 2015; 30: 34-39.
Pedersen SJ, Sørensen IJ, Hermann KA, Madsen OR, Tvede N, Hansen MS, Thamsborg G, Andersen LS, Majgaard O, Loft AG et al. Responsiveness of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and clinical and MRI measures of disease activity in a 1-year follow-up study of patients with axial spondyloarthritis treated with tumor necrosis factor alpha inhibitors. Ann Rheum Dis 2010; 69: 1065-1071.
Nas K, Yıldırım K, Çevik R, Karatay S, Erdal A, Baysal O, Altay Z, Kamanlı A, Erson Y, Kaya A et al. Discrimination ability of ASDAS in estimating disease activity status in patient with ankylosing spondylitis. Int J Rheum Dis 2010; 13: 240-245.
Wu Q, Inman RD, Davis KD. Tumor necrosis factor inhibitor therapy in ankylosing spondylitis: differential effects on pain and fatigue and brain correlates. Pain 2015; 156: 297-304.
Fitzcharles MA, Almahrezi A, Shir Y. Pain: understanding and challenges for the rheumatologist. Arthritis Rheum 2005; 52: 3685-3692.
McWilliams DF, Zhang W, Mansell JS, Kiely PD, Young A, Walsh DA. Predictors of change in bodily pain in early rheumatoid arthritis: an inception cohort study. Arthritis Care Res 2014; 64: 1505-1513.
Salaffi F, De Angelis R, Carotti M, Gutierrez M, SarziPuttini P, Atzeni F. Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity. Rheumatol Int 2014; 34: 1103-1110.
Haliloglu S, Carlioglu A, Akdeniz D, Karaaslan Y, Kosar A. Fibromyalgia in patients with other rheumatic diseases: prevalence and relationship with disease activity Rheumatol Int 2014; 34: 1275-1280.
Almodovar R, Carmona L, Zarco P, Collantes E, González C, Mulero J, Fernández J, Gratacós J, Torre J, Juanola X et al. Fibromyalgia in patients with ankylosing spondylitis: prevalence and utility of the measures of activity, function and radiological damage Clin Exp Rheumatol 2010; 28: 33-39. 47. Clauw DJ. Fibromyalgia: a clinical review. JAMA 2014; 311: 1547-1555.