Central sensitization reduces the satisfaction of patients with rheumatoid arthritis. The data of prospective study

Central sensitization (CS) is a pathophysiological phenomenon that plays a fundamental role in the development of chronic pain and fibromyalgia. The presence of CS can significantly worsen the condition of patients with rheumatoid arthritis (RA) and reduce the response to antirheumatic therapy.
The aim of the study – to evaluate the effect of central sensitization on satisfaction in patients with rheumatoid arthritis.
Material and methods. The study group consisted of 521 patients with a reliable diagnosis of RA (ACR/EULAR (American College of Rheumatology / European Alliance of Associations for Rheumatology) 2010 criteria), 82.3% of women, 52.0±14.3 years old, with moderate and high disease activity (DAS28-CRP (Disease Activity Score with C-reactive protein) – 4.7±1.0), observed at the clinic of the V.A. Nasonova Research Institute of Rheumatology in 2021– 2022. During hospitalization, all patients underwent correction of the individual therapeutic regimen. At the time of discharge, therapy with genetically engineered biologic DMARDs or Janus kinase inhibitors (JAKi) was continued, induced or modified in 364 patients (69.8%). The presence of a CS was determined by the CSI (Central Sensitisation Inventory) and painDETECT questionnaires. Satisfaction with their condition was assessed during a telephone survey using the PASS index (patient acceptable symptom state) 6 months after discharge from the hospital.
Results. Signs of CS according to the CSI questionnaire (≥40 points) were noted in 56.0%, according to the pain- DETECT questionnaire (>18 points) – in 22.5% of patients. A telephone survey was conducted after 6 months in 473 patients (90.8%). 52.0% of respondents considered their condition acceptable (PASS “+”). PASS “+” was significantly more common in patients receiving biologic DMARDs or JAKi, compared with those receiving only synthetic (s) DMARDs: 65.0% and 33.6% (p<0.001). In patients with signs of CS according to CSI, the PASS index “+” was noted in 41.7%, without signs of CS in 65.0% (p<0.001), with signs of CS according to painDETECT, the PASS index “+” was noted in 40.6%, without signs of CS in 55.6% (p<0.001). A significantly lower frequency of PASS “+” was observed in patients with CS both on the background of taking biologic DMARDs or JAKi, and on the background of taking only sDMARDs.

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