Chronic Pain and Assessment of Pain Sensitivity in Patients With Axial Spondyloarthritis: Results From the SPARTAKUS Cohort

Elisabeth Mogard; Tor Olofsson; Stefan Bergman; Ann Bremander; Lars Erik Kristensen; Jack Kvistgaard Olsen; Johan K Wallman; Elisabet Lindqvist

doi:10.3899/jrheum.200872

Chronic Pain and Assessment of Pain Sensitivity in Patients With Axial Spondyloarthritis: Results From the SPARTAKUS Cohort

J Rheumatol. 2021 Nov;48(11):1672-1679. doi: 10.3899/jrheum.200872. Epub 2020 Dec 15.

Authors

Elisabeth Mogard¹, Tor Olofsson², Stefan Bergman³, Ann Bremander⁴, Lars Erik Kristensen⁵, Jack Kvistgaard Olsen⁶, Johan K Wallman², Elisabet Lindqvist²

Affiliations

¹ E. Mogard, PT, PhD, T. Olofsson, MD, PhD, J.K. Wallman, MD, PhD, E. Lindqvist, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, and Skåne University Hospital, Department of Rheumatology, Lund, Sweden; elisabeth.mogard@med.lu.se.
² E. Mogard, PT, PhD, T. Olofsson, MD, PhD, J.K. Wallman, MD, PhD, E. Lindqvist, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, and Skåne University Hospital, Department of Rheumatology, Lund, Sweden.
³ S. Bergman, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, and Spenshult Research and Development Centre, Halmstad, Sweden.
⁴ A. Bremander, PT, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Spenshult Research and Development Centre, Halmstad, Sweden, Department of Regional Health Research, University of Southern Denmark, Odense, and Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.
⁵ L.E. Kristensen, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden, and The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark.
⁶ J. Kvistgaard Olsen, BSc, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark.

PMID: 33323532
DOI: 10.3899/jrheum.200872

Abstract

Objective: To study differences in pain reports between patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA), and to assess how pain sensitivity measures associate with disease and health outcomes.

Methods: Consecutive patients with axial SpA (axSpA) were enrolled in the population-based SPARTAKUS cohort (2015-2017) and classified as AS (n = 120) or nr-axSpA (n = 55). Pain was assessed with questionnaires (intensity/duration/distribution) and computerized cuff pressure algometry to measure pain sensitivity (pain threshold/pain tolerance/temporal summation of pain). Linear regression models were used to compare pain measures between patients with AS and nr-axSpA, and to assess associations between pain sensitivity measures and disease and health outcomes.

Results: Of 175 patients with axSpA, 43% reported chronic widespread pain, with no significant differences in any questionnaire-derived or algometry-assessed pain measures between patients with AS and nr-axSpA. Lower pain tolerance was associated with longer symptom duration, worse Ankylosing Spondylitis Disease Activity Score using C-reactive protein (ASDAS-CRP), Bath Ankylosing Spondylitis Functional Index, and Bath Ankylosing Spondylitis Metrology Index (BASMI), more pain regions, unacceptable pain, worse Maastricht AS Enthesitis Score (MASES), fatigue, anxiety, and health-related quality of life. Further, lower pain threshold was associated with worse ASDAS-CRP and MASES, whereas higher temporal summation was associated with longer symptom duration, unacceptable pain, and worse BASMI.

Conclusion: Chronic pain is common in axSpA, with no observed differences in any pain measures between patients with AS and nr-axSpA. Further, higher pain sensitivity is associated with having worse disease and health outcomes. The results indicate that patients with AS and nr-axSpA, in line with most clinical characteristics, have a similar pain burden, and they highlight large unmet needs regarding individualized pain management, regardless of axSpA subgroup.

Keywords: ankylosing spondylitis; chronic pain; health; pain thresholds; spondyloarthritis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Chronic Pain* / diagnosis
Humans
Pain Measurement
Pain Threshold
Quality of Life
Severity of Illness Index
Spondylarthritis* / complications
Spondylarthritis* / diagnosis
Spondylitis, Ankylosing* / complications