The relationship between central sensitization and disease activity, quality of life, and sleep quality among patients with axial spondyloarthritis.

Abstract

Central sensitization (CS) has been held responsible in previous studies for persistent pain and persistently high disease activity in axial spondyloarthritis (axSpA). Sleep disturbance is also regarded as an important problem for patients with axSpA. This study determines the CS levels of patients with axSpA compared to healthy controls (HC) and investigates its relationship with disease activity, quality of life (QoL), and sleep quality. Eighty-two patients with axSpA (group 1: mean age 38.83 ± 10.11 (76.8%male)) and 40 healthy volunteers (group2: mean age 38.58 ± 7.48 (77.5%male)) were included in this cross-sectional observational study. Evaluation parameters were visual analog scale (VAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Short Form-36 (SF-36), Central Sensitization Inventory (CSI), and Pittsburgh Sleep Quality Index (PSQI). Also, participants were divided into subgroups as CSI < 40 and CSI ≥ 40. Groups were compared to themselves. A correlation between the patients' CSI scores and other evaluation parameters was examined. CS rates were 45.1% and 7.5% for axSpA and HC, respectively (p < 0,001). The frequency of severe forms of CS was higher in patients with axSpA than in the healthy controls (p < 0.05). AxSpA patients with CS exhibited significantly higher pain, MASES, BASDAI, ASDAS-CRP, and PSQI scores than axSpA patients without CS (p < 0.05). A close relationship between CS severity and the female gender, pain, disease activity, sleep quality, and QoL was found among axSpA patients. Clinical CS is common among axSpA patients. CS adversely affects disease activity, pain, sleep quality, and QoL of axSpA patients. CS should be considered when planning axSpA treatment.