Prevalence of Migraine and Neuropathic Pain in Rheumatic Diseases.

Sandrine Malochet-Guinamand,Martin Soubrier,Marion Couderc,Jean-Jacques Dubost,Sylvain Mathieu,Anne Tournadre,Bruno Pereira,Xavier Moisset

doi:10.3390/jcm9061890

Abstract

To investigate the physiopathology of pain in chronic inflammatory rheumatic diseases (CIRDs), we assessed the prevalence of migraine and neuropathic pain in 499 patients with CIRDs. We studied 238 patients with rheumatoid arthritis, 188 with spondyloarthritis (SpA), 72 with psoriatic arthritis (PsA), and 1 unclassified. Migraine was diagnosed according to IHS migraine diagnostic criteria. Neuropathic pain was diagnosed when patients scored at least 3 on the DN4 questionnaire. Participants completed a validated self-assessment questionnaire. Migraine prevalence was 34% (165/484), and it was highest in PsA. Risk factors for migraine were a high level of anxiety, female sex, young age, and TNF-alpha inhibitor treatment (OR = 1.90 (1.13–3.25)). Besides, high disease activity was a risk factor in SpA. Blood CRP level was not significantly associated with migraine. Of 493 patients with CIRDs, 21.5% had chronic pain with neuropathic characteristics. Compared to the French general population, these patients had significantly higher prevalences of migraine (two-fold) and neuropathic pain (three-fold). This study showed that migraine and neuropathic pain frequently occurred in patients with rheumatic diseases. Therefore, upon reporting residual pain, these patients should be checked for the presence of migraine or neuropathic pain, despite adequate clinical control of rheumatic disease.

Highlights

Chronic inflammatory rheumatoid diseases (CIRDs) are a class of rheumatic diseases that includes rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA)
Many studies have described a link between chronic inflammatory activity and the risk of migraine in multiple sclerosis and inflammatory bowel disease [10,11], very few studies have described the occurrence of migraine in CIRDs
This study showed that patients with rheumatic disease had a two-fold increase in migraine prevalence (34%) and a three-fold increase in neuropathic pain prevalence (21.5%) compared to the general population

Summary

Introduction

Chronic inflammatory rheumatoid diseases (CIRDs) are a class of rheumatic diseases that includes rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA). The most likely hypothesis is that the nociceptive pathways are sensitized and endogenous controls of nociception are altered in CIRDs, a chronic algogenic disease. This condition might be described as the presence of a fibromyalgia state associated with CIRDs. Clauw et al reported that 10–30% of patients with RA, osteoarthritis, or lupus met the criteria for fibromyalgia [3]. A recent study showed that the frequency of neuropathic pain, defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system, was relatively high among patients with RA, PsA, or SpA, without necessarily meeting the criteria for fibromyalgia [8]. As there was a rationale for an increased prevalence of both migraine and neuropathic pain types in CIRDs, we decided to study both in the same study

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