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- Mogard, E., et al.
(författare)
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Chronic Pain in Patients With Established Axial Spondyloarthritis and Assessment of Pain Sensitivity by Computerized Pneumatic Cuff Pressure Algometry : Results from the Spartakus Cohort
- 2017
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 76:Suppl. 2, s. 651-651
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pain is a common symptom in all arthritides, and remains a problem also with better treatment options. In axial spondyloarthritis (ax-SpA), data on chronic pain remain scarce.Objectives: To study pain distribution, duration and intensity in ax-SpA, and relate this to disease status and measurement of pressure pain sensitivity.Methods: Consecutive patients (n=115) with clinical ax-SpA diagnoses (ankylosing spondylitis (AS) or undifferentiated axial spondyloarthritis (USpA)) were examined and answered pain questionnaires. Patients were categorised as having no chronic pain (NCP), chronic regional pain (CRP) or chronic widespread pain (CWP). Pressure pain sensitivity was assessed by computerized pneumatic cuff pressure algometry (CPA) on the dominant lower leg, and pain threshold, pain tolerance and temporal summation (assessed by the temporal summation index, TSI) were recorded. Differences in disease status and pressure pain sensitivity between patients with CWP versus NCP were assessed (Chi-square or Mann-Whitney U-test). Pressure pain sensitivity was also compared between patients with/without unacceptable pain levels (VAS pain >40 versus ≤40; Mann-Whitney U-test).Results: Fifty percent of patients reported CWP, irrespective of clinical diagnosis (AS 47%, USpA 53%), and more women than men reported CWP (59% versus 37%, p<0.001). Only 18% of all patients reported NCP. Overall, higher disease activity, pain intensity, worse fatigue, global health and function were observed among patients with CWP compared to those with NCP. There was a trend towards lower pain tolerance in patients with CWP compared to NCP (Table). Lower pain tolerance and higher TSI scores were observed among patients reporting VAS pain >40 versus those with VAS pain scores ≤40 ((mean (SD)) 51.9 (21.2) versus 68.1 (28.1), p=0.007; 0.73 (0.60) versus 0.55 (0.59), p=0.045). 2017, BMJ Publishing Group Limited.
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- Mogard, E., et al.
(författare)
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Risk factors for development and persistence of chronic widespread pain, in ankylosing spondylitis and undifferentiated spondyloarthritis
- 2017
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 76:Suppl. 2, s. 922-922
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Tidskriftsartikel (refereegranskat)abstract
- Background Chronic back pain is a prominent symptom in Spondyloarthritis (SpA), and an important contributor to diminished quality of life (1,2). Chronic pain can develop in intensity, become more spread, and progress to chronic widespread pain (2). Mechanisms for this are yet inconsistent (3), and in SpA, knowledge of progression to chronic widespread pain (CWP) is lacking.Objectives To study the development of CWP in patients with SpA, and to identify risk factors for development and persistence of CWP.Methods A cohort study with baseline and 2.5-year follow-up postal surveys. 644 patients (47% women) with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (SpA) answered both surveys, and were categorized as no chronic pain (NCP), chronic regional pain (CRP), and CWP. Logistic regression analyses, with CWP as the main outcome were performed. Due to multicollinearity, each risk factor candidate (disease duration, BMI, smoking, and different patient-reported outcome measures; PROMs) were analysed in separate logistic regression models together with a base model (age, sex, and SpA-subgroup).Results At follow-up, prevalence estimates for NCP, CRP and CWP were similar to those at baseline, but 38% of the patients had transitioned between the groups. A large group, 72% of the patients with initial CWP, also reported persistent CWP at follow-up (Figure). Risk factors (OR and 95% CI) for development of CWP from initial NCP/CRP were more pain regions (1.36; 1.20–1.53), pain intensity (1.35; 1.20–1.52), fatigue (1.25; 1.13–1.38), global health (1.35; 1.19–1.54), EQ-5D (0.05; 0.01 – 0.19), BASDAI (1.25; 1.07 – 1.45), BASFI (1.32; 1.16 – 1.50), ASES pain (0.97; 0.96 – 0.99), ASES symtom (0.98; 0.97 – 0.99), and HADb (1.10; 1.02 – 1.19). The risk factors for persistent CWP, compared to patients transitioning to NCP or CRP, were similar to those predicting development of CWP, but in addition, also higher age (1.02; 1.00–1.04), and female sex (1.82; 1.06–3.10), predicted the outcome. © 2017 BMJ Publishing Group Limited.
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- Mogard, E., et al.
(författare)
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Risk factors for development and persistence of chronic widespread pain in spondyloarthritis : a population-based two-year follow-up study
- 2019
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Ingår i: Scandinavian Journal of Rheumatology. - : Informa UK Limited. - 0300-9742 .- 1502-7732. ; 48:6, s. 460-468
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study chronic widespread pain (CWP) over time in patients with spondyloarthritis (SpA), and to identify risk factors for development and persistence of CWP. Methods: In this cohort study with baseline and 2.5 year follow-up postal surveys, patients with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA) (47% women) answered questions regarding pain, and were categorized as no chronic pain (NCP), chronic regional pain (CRP), or CWP. For each risk factor candidate (disease duration, body mass index, smoking, and patient-reported outcome measures), logistic regression analyses with CWP as the main outcome were performed separately, together with a basic model including age, gender, and SpA subgroup. Results: Altogether, 644 patients could be categorized at both time-points, yielding similar prevalence estimates at baseline and follow-up, although 38% transitioned between pain groups. Risk factors (odds ratio; 95% confidence interval) for development of CWP included more pain regions (1.36; 1.20‒1.53), higher pain intensity (1.35; 1.20‒1.52), worse fatigue (1.25; 1.13‒1.38), and worse global health (1.35; 1.19‒1.54). Persistent CWP was reported by 72%. In addition to factors predicting development of CWP, higher age (1.02; 1.00‒1.04), female gender (1.82; 1.06‒3.10), and anxiety (1.07; 1.00–1.14) also predicted persistence. Conclusion: The prevalence of CWP remained high over time, but with individual transitions between the pain groups. The development and persistence of CWP were predicted by more pain and worse health, with the addition of female gender and higher age for persistent CWP. Special attention and treatment alternatives for patients with SpA and concomitant CWP are essential in the clinic.
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