Central Sensitization Associated With Poorer QOL, Greater Disease Activity in axSpA

Patients with axial spondyloarthritis (axSpA) and concurrent central sensitization report higher levels of disease activity, poorer quality of life (QOL), and higher rates of fibromyalgia and neuropathic pain, according to study findings published in Journal of Rheumatic Diseases.

Pain is a common symptom among patients with axSpA and can be caused by the heightened neural response accompanying painful stimuli during central sensitization. It is estimated that nearly 15% to 40% of patients with rheumatic disease also have central sensitization.

In a cohort of patients with axSpA, researchers investigated the effects of central sensitization on disease activity, quality of life, and clinical parameters.

From July 2021 and November 2021, patients and control participants were evaluated using the central sensitization inventory (CSI) for quality of life, the American College of Rheumatology (ACR) fibromyalgia diagnostic criteria, and douleur neuropathique 4 (DN4) questionnaire.

A total of 211 participants were included in the study (axSpA; n=116; control; n=95). Mean age of all patients was 41.8±10.7 years. Of the patients with axSpA, 81% reported morning stiffness and 23.3% reported neuropathic pain.

Central sensitization was confirmed in 46.6% of patients with axSpA and 13.7% of control participants. Patients with axSpA and central sensitization were more likely to be women (59.3%) and report morning stiffness (94.4%) and higher median pain scores (mean score of 7 on visual analog 10-point scale) than those without central sensitization. Greater rates of fibromyalgia and neuropathic pain were also reported among patients with axSpA and central sensitization (both P <.0001).

Rates of anxiety and depression were higher among patients with axSpA (both P <.05). Higher CSI scores, denoting poorer quality of life, were also reported in the patient vs control group.

Study limitations included the relatively small sample size, data were collected during the COVID-19 pandemic, the use of cross-sectional analysis that prevented researchers from evaluating long-term changes in central sensitization and other disease progressions.

Study authors concluded, “[Central sensitization], [fibromyalgia], and [neuropathic pain] need to be considered in the treatment plans of [patients with] axSpA.”