Abstract
ObjectivesThe primary objective was to investigate the prevalence of neuropathic-like pain in patients with psoriatic arthritis (PsA). Secondary outcomes were to investigate whether mood, fatigue, pain, disease severity and fibromyalgia are associated with neuropathic-like pain in PsA patients.MethodsPsA patients were assessed for fatigue, mood, pain, disease activity and fibromyalgia using questionnaires. Neuropathic-like pain was assessed by PainDetect.ResultsSixty-four patients with PsA were recruited from the Rheumatology Outpatient Department. Of the 64 patients recruited, 26.6% had ‘likely neuropathic pain’ and 21.9% had ‘possible neuropathic-like pain’ according to the PainDetect questionnaire. Patients with ‘likely neuropathic pain’ had higher disease activity, health assessment questionnaire, patient global self-assessment score, tender and swollen joint counts, dactylitis, enthesitis, pain severity and interference with day-to-day activities, fatigue severity and impact, fibromyalgia, anxiety and depression than ‘unlikely neuropathic pain’ patients (p < 0.05). PainDetect score correlated with measures of disease activity, fatigue, depression, anxiety, Widespread Pain Index and Symptom Severity Scale (all p < 0.05). Most patients (71%) with neuropathic-like pain fulfilled American College of Rheumatology 2010 fibromyalgia criteria. Patients with ‘possible neuropathic-like pain’ had scores between patients with ‘likely neuropathic pain’ and ‘unlikely neuropathic pain’.ConclusionNeuropathic-like pain as evidence of abnormal pain processing is common in patients with PsA. It is associated with higher disease activity and fibromyalgia. A significant proportion of patients had ‘possible neuropathic-like’ pain with intermediate disease and symptom score suggesting neuropathic-like pain as evidence of abnormal pain processing is a continuum rather than concurrent fibromyalgia.Key Points• Neuropathic pain is prevalent in psoriatic arthritis.• Higher levels of pain, disease activity, fatigue, depression, anxiety and comorbidities in Psoriatic arthritis.• Increased pain severity is associated with increased disease activity, fatigue, depression and anxiety.
Highlights
Pain is the most common complaint in patients with musculoskeletal diseases
From their PainDetect score, seventeen (26.6%) patients were classified into the ‘likely neuropathic pain’ (NP) group, fourteen (21.9%) patients were classified into the ‘possible neuropathic pain’ (PNP) group and 33 (51.6%) patients were classified into the ‘unlikely neuropathic pain’ (UNP) group
Disease duration was longest and the number of concomitant diseases was highest in the NP and PNP groups compared with the UNP group, these differences were not significant (p = 0.161 and 0.077)
Summary
Pain is the most common complaint in patients with musculoskeletal diseases. Patients with inflammatory arthritis (IA) such as rheumatoid arthritis (RA) ranked pain as the most important symptom [1], which has a major detrimental impact on their quality of life [2]. Neuropathic pain is a type of pathological pain [5] and defined as “pain initiated or caused by a primary lesion or dysfunction in the nervous system” [6]. It can affect both the peripheral and central nervous system and may be caused by a variety of pathophysiological mechanisms such as inflammatory reactions and neuroplastic changes [7]. QST allows for quantification of assessment of perception thresholds for light touch, vibration, thermal and pain sensation [9]
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