Clinical and neuropsychological characteristics of patients with rheumatoid arthritis depending on pain level associated with the severity of central sensitization. Part 1.

Abstract

Objective : to determine the effect of central sensitization (CS) severity on the clinical symptoms of rheumatoid arthritis (RA) and neuropsychological manifestations. Patients and methods . A total of 59 patients with RA (11 men and 48 women) were examined; their mean age was 52.0 years (range 19–75 years). Clinical status was assessed using the DAS28 index; serum levels of antibodies to cyclic citrullinated peptide (ACPA), CRP, and rheumatoid factor (RF) were determined. X-ray was performed to identify structural joint changes. The visual analog scale (VAS) and the CSI, BPI, PainDETECT, HADS, FSS, FiRST, and FACIT-F questionnaires were used to assess signs of CS and the severity of pain, anxiety, depression, fatigue, and fibromyalgia. Results and discussion . All patients had high disease activity. Most patients were positive for RF and ACPA and had erosions, tender and swollen joints, morning stiffness, and moderate VAS pain intensity. Clinically, the disease corresponded to the established and late stages. Abnormalities were also identified using the Hospital Anxiety and Depression Scale and questionnaires assessing CS, pain severity, neuropathic pain, fibromyalgia, fatigue, pain catastrophizing, and resilience. The patients were divided into four subgroups according to CS severity. Conclusion . The presence of CS leads to increased pain sensitivity and overestimation of disease activity in patients with RA. The CSI questionnaire is a practical tool for diagnosing CS in patients with RA.