Characteristics of pain and their relationship to disease activity in UK patients with Behçet's syndrome: a prospective cohort study

K Plant; A Goebel; J Nair; R Moots; L Chadwick; N Goodson

doi:10.1177/20494637231198200

Characteristics of pain and their relationship to disease activity in UK patients with Behçet's syndrome: a prospective cohort study

Br J Pain. 2023 Dec;17(6):560-568. doi: 10.1177/20494637231198200. Epub 2023 Aug 29.

Authors

K Plant^{1

2}, A Goebel^{3

4}, J Nair^{1

5}, R Moots^{1

5}, L Chadwick¹, N Goodson^{1

6}

Affiliations

¹ Department of Rheumatology, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.
² Faculty of Health and Life Sciences, Liverpool University, Liverpool, UK.
³ Pain Research Institute, University of Liverpool, Liverpool, UK.
⁴ Department of Pain Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK.
⁵ Department of Rheumatology, National Behcet's Centre of Excellence, Liverpool, UK.
⁶ Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.

Abstract

Background: Behçet's syndrome (BS) is a rare multi-systemic vasculitis of unknown aetiology. Fibromyalgia syndrome (FMS) is more prevalent in rheumatological conditions such-as BS, than the general population. However, there is limited research into the aetiology and characteristics of pain in BS.

Objectives: To describe the pain characteristics and incidence of FMS in people with BS and investigate their relationship with BS disease activity.

Methods: A cohort study of BS patients attending the Liverpool Behçet's Centre between February 2017 and March 2019. BS was defined using the International Study Group Criteria. BS severity was assessed using the Behçet's Disease Current Activity Form. FMS was determined from consultant diagnosis. Assessments of pain included: Pain Visual Analogue Scale (PVAS), Pain Mannequin, Brief Pain Inventory, EQ-5D-3L and Short Form McGill. Pain and FMS prevalence were compared between high and low disease activity.

Results: 90% reported moderate-severe pain with a median PVAS score of 68/100 [38, 81]. 35.6% of participants had FMS and 46.5% experienced generalized pain. 76% of participants with high disease activity reported severe pain, compared to 39.1% with low disease activity (p = .003). Pain was more generalised in high disease activity (72%) compared to low disease activity (37.7%) (p = .003). FMS was more prevalent in the high disease activity group (52%) than the low disease activity group (29%) (p = .04).

Conclusions: This is the first study to explore pain in participants with BS in the United Kingdom. The majority of BS patients experience moderate-severe widespread pain. Severe widespread pain is more prevalent in those with high disease activity. We have demonstrated a relationship between high disease activity, worse pain intensity, and FMS. This paper contributes to the understanding of two conditions which remain to be fully understood, FMS and BS, and generates new hypotheses to describe the interplay between.

Keywords: chronic pain; fibromyalgia; musculoskeletal pain; pain measurement; pain perception.