Biopsychosocial factors should be considered when evaluating central sensitization in axial spondyloarthritis

Aylin Sariyildiz; Ilke Coskun Benlidayi; Ipek Turk; Serife Seyda Zengin Acemoglu; Ilker Unal

doi:10.1007/s00296-023-05317-2

Biopsychosocial factors should be considered when evaluating central sensitization in axial spondyloarthritis

Rheumatol Int. 2023 May;43(5):923-932. doi: 10.1007/s00296-023-05317-2. Epub 2023 Mar 26.

Authors

Aylin Sariyildiz¹, Ilke Coskun Benlidayi², Ipek Turk³, Serife Seyda Zengin Acemoglu³, Ilker Unal⁴

Affiliations

¹ Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Cukurova University, Adana, Turkey. aylingoksen@hotmail.com.
² Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Cukurova University, Adana, Turkey.
³ Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Cukurova University, Adana, Turkey.
⁴ Faculty of Medicine, Department of Biostatistics, Cukurova University, Adana, Turkey.

Abstract

To identify the determinants of central sensitization (CS) in patients with axial spondyloarthritis (axSpA). Central Sensitization Inventory (CSI) was used to determine CS frequency. Disease-related variables including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP/-ESR), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) and Numeric Rating Scale (NRS)_GLOBAL were assessed. Biopsychosocial variables were evaluated by the Multidimensional Scale of Perceived Social Support (MSPSS), Brief Illness Perception Questionnaire (B-IPQ), Hospital Anxiety and Depression Scale (HADS) and subscales for Anxiety (HADS-A) and Depression (HADS-D), and Jenkins Sleep Evaluation Scale (JSS). To determine the predictors of the development and severity of CS, multiple linear and logistic regression analyses were performed. The frequency of CS was 57.4% in the study population (n = 108). CSI score was correlated with the duration of morning stiffness, BASDAI, ASDAS-CRP, ASDAS-ESR, NRS_GLOBAL, BASFI, MASES, ASOoL, JSS, HADS, and B-IPQ total scores (ρ ranged from 0.510 to 0.853). Multiple regression analysis indicated that BASDAI (OR: 10.44, 95% CI: 2.65-41.09), MASES (OR: 2.47, 95% CI: 1.09-5.56) and HADS-A (OR: 1.62, 95% CI: 1.11-2.37) were independent predictors of the development of CS. Additionally, higher NRS_GLOBAL, JSS, HADS-D, and HADS-A scores appeared to determine the severity of CS. This study confirms that worse disease activity, more enthesal involvement, and anxiety independently predict the development of CS. Additionally, higher patient-perceived disease activity, sleep impairment and poor mental health significantly contribute to the severity of CS.

Keywords: Axial spondyloarthritis; Biopsychosocial; Central sensitization; Psychological factors.

MeSH terms

Anxiety / diagnosis
Central Nervous System Sensitization
Humans
Quality of Life / psychology
Severity of Illness Index
Spondylitis, Ankylosing* / epidemiology
Surveys and Questionnaires