Neuropathic pain in spondyloarthritis: Decoding its prevalence, risk factors, and impact on disease activity

Giuseppe Lopalco; Sergio Del Vescovo; Maria Morrone; Andrea Cito; Marco Fornaro; Eugenio Capparelli; Eneida Cela; Maria Sole Chimenti; Florenzo Iannone

doi:10.1016/j.semarthrit.2024.152557

Neuropathic pain in spondyloarthritis: Decoding its prevalence, risk factors, and impact on disease activity

Semin Arthritis Rheum. 2024 Sep 27:69:152557. doi: 10.1016/j.semarthrit.2024.152557. Online ahead of print.

Authors

Giuseppe Lopalco¹, Sergio Del Vescovo², Maria Morrone², Andrea Cito², Marco Fornaro², Eugenio Capparelli³, Eneida Cela³, Maria Sole Chimenti³, Florenzo Iannone²

Affiliations

¹ Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Bari, Italy. Electronic address: giuseppe.lopalco@uniba.it.
² Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Bari, Italy.
³ Reumatology, allergology and clinical immunology University of Rome Tor Vergata, Rome, Italy.

PMID: 39357168
DOI: 10.1016/j.semarthrit.2024.152557

Abstract

Objectives: This study aimed to evaluate the prevalence and characteristics of neuropathic pain in patients with various subtypes of spondyloarthritis (SpA), including axial SpA (axSpA), psoriatic arthritis (PsA), and undifferentiated peripheral SpA (p-SpA). Additionally, the study sought to identify potential risk factors associated with the presence or severity of neuropathic pain and to investigate its impact on clinical disease activity assessment.

Methods: We conducted a cross-sectional study at two tertiary rheumatology centers, enrolling patients diagnosed with SpA. Data on demographic and clinical characteristics, comorbidities, and current therapies were collected. Neuropathic pain was assessed using the PainDETECT Questionnaire (PD-Q) and the Neuropathic Pain Symptom Inventory (NPSI). Statistical analyses included descriptive statistics, t-tests, and Pearson's correlations to evaluate the relationships between neuropathic pain scores and clinical disease activity indices.

Results: The study included 177 patients. Of these, 22.2% had a PD-Q score ≥19, showing a high likelihood of neuropathic pain, while 64.9% scored ≤12, suggesting the absence of significant neuropathic components. The mean PD-Q score was 11.5 ± 10.1. Subgroup analyses showed that females had significantly higher scores for paroxysmal and evoked pain (p < 0.05), and obese patients had significantly higher scores across all NPSI subscores (p < 0.05). Moderate positive correlations were found between neuropathic pain scores and clinical disease activity indices, such as DAPSA (r = 0.46, p < 0.0001) and ASDAS-CRP (r = 0.42, p < 0.01).

Conclusions: Neuropathic pain is prevalent among patients with SpA and is significantly associated with disease activity assessments and management. This study highlights the importance of integrating neuropathic pain evaluation into the clinical assessment of SpA to tailor treatment approaches effectively and improve patient outcomes.

Keywords: Biologic drugs; Neuropathic pain; Precision medicine; Psoriatic arthritis; Spondyloarthritis.