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在患有活性类风湿性关节炎的患者中,疼痛敏感化和关节炎症

Khaldoun Chaabo¹, Estee Chan¹, Toby Garrood¹

¹Rheumatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK.

|March 20, 2024

概括

风湿性关节炎患者患有纤维肌痛往往会经历持续的疼痛. 这项研究发现,虽然纤维肌痛和关节炎影响疼痛,但仅仅通过临床评估并不总能确定这些子组,这凸显了超声波的重要性.

科学领域:

类风湿病学类风湿病学
疼痛医学医学疼痛医学
肌肉骨成像系统的成像

背景情况:

类风湿性关节炎 (RA) 中持续的疼痛往往与鼻膜性疼痛有关,这种疼痛处理异常的情况.
风湿性关节炎患者患有纤维肌痛 (FM),这是一个中心的nociplastic疼痛综合征,也可能表现出通过电力多普勒超声波 (PDUS+) 检测到的关节炎症.
了解RA,FM和关节炎之间的相互作用对于管理持续性疼痛至关重要.

研究的目的:

通过结合临床检查,患者报告的结果测量 (PROM) 和功率多普勒超声波 (PDUS) 来调查类风湿性关节炎患者持续疼痛的复杂原因.
根据纤维肌痛 (FM) 和/或功率多普勒超声波 (PDUS+) 检测到关节炎症的存在来区分类风湿性关节炎患者.
探索类风湿性关节炎患者 (包括没有可检测到关节炎症的患者) 潜在的鼻膜性疼痛机制.

主要方法:

一项涉及158名类风湿性关节炎患者的横截面研究,这些患者患有中度至高的疾病活性.
评估包括临床关节计数,FM诊断标准,功能,生活质量和情绪的PROM,以及44个关节的PDUS评估.
统计分析采用了逻辑回归和正则化 (lasso) 逻辑回归来识别不同的患者群体.

主要成果:

46%的类风湿性关节炎患者符合纤维肌痛的标准,报告疼痛和PROMs更糟,但与非FM患者相比,PDUS发现没有差异.
确定了四组患者:没有FM/没有PDUS+ (27.2%),没有FM/没有PDUS+ (27.2%),没有FM/没有PDUS+ (26.6%),和没有FM/没有PDUS+ (19%).
纤维肌痛患者 (FM+) 始终报告疲劳,情绪和疼痛结果较差,无论PDUS发现如何.

结论:

一个显著的类风湿性关节炎患者 (-FM-PD) 的小组可能会经历外围鼻膜性疼痛,这并不总是与可检测的关节炎症相关.
功率多普勒超声波 (PDUS) 仍然是评估类风湿性关节炎关节炎症的重要工具,因为仅通过临床评估和PROM无法可靠地区分患者群体.
该研究强调了类风湿性关节炎疼痛机制的异质性,以及需要全面的评估策略.

关键词:

关节炎,类风湿性关节炎纤维肌痛是一种纤维肌痛.患者报告的结果措施

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