Journal Article

POS0299 NEUROPATHIC AND NEUROPLASTIC PAIN COMPONENTS DETERMINE THE PRESENCE OF RESIDUAL SYMPTOMS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS RECEIVING BIOLOGICAL DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS

Haibel, H., Sieper, J., Al Mohamad, F., Protopopov, M., Torgutalp, M., Proft, F., Rios Rodriguez, V., Rademacher, J., Käding, H., Poddubnyy, D.

2023

Overview

Several studies have investigated neuropathic pain (NP) as a component of chronic pain in patients with axial spondyloarthritis (axSpA)/ ankylosing spondylitis (AS) and showed a wide frequency range from 22 – 56.9% [1, 2]. Neuroplastic processes leading to central sensitization have been described as another component of pain chronification in rheumatic diseases [3]. Widespread pain is considered a characteristic of central sensitization [4]. It is, however, unclear, what is the relevance of neuropathic and neuroplastic components of pain for the treatment response and the presence of residual symptoms in patients with radiographic axSpA (r-axSpA) treated with biological disease-modifying anti-rheumatic drugs (bDMARDs) To investigate the impact of neuropathic pain and neuroplastic/ widespread pain on residual disease activity in patients with r-axSpA receiving (bDMARDs). Patients with r-axSpA (AS fulfilling the modified New York criteria) and starting a bDMARD therapy were recruited between 2015 and 2019 and followed up in an extension of the prospective German Spondyloarthritis Inception Cohort (GESPIC). Neuropathic pain was quantified using the pain detect questionnaire (PD), whereas neuroplastic pain was quantified using the Widespread Pain Index (WPI). Disease activity was measured using the Ankylosing Spondylitis Disease Activity Score – C-reactive protein (ASDAS-CRP) score. Simple and multiple linear and logistic regression analyses were performed to determine the effects of NP and WPI on the ASDAS status score under bDMARD treatment. A total of 130 patients with r-axSpA were included in this cohort. PD and WPI scores were available at at least one follow-up time-point in 99 patients. Of these 70 were receiving bDMARD treatment (n=68 under TNFi and n=2 under IL17 inhibitors) with no missing data and could be included in this analysis. The first follow-up point with available PD and WPI scores while under bDMARD treatment was used for the analysis. [Display omitted] Both PD and WPI reflecting neuropathic and neuroplastic components of pain showed association with residual symptoms (as reflected by higher ASDAS) independently of systemic inflammation (as reflected by elevated CRP) in patients with r-axSpA receiving bDMARD treatment. [1]Kim, T.W., S.M. Son, and J.S. Lee, Neuropathic pain in ankylosing spondylitis: a meta-analysis. Z Rheumatol, 2020. 79(1): p. 95-102. [2]Borman, P., F. Kaygisiz, and A. Yaman, Neuropathic component of low back pain in patients with ankylosing spondylitis. Mod Rheumatol, 2021. 31(2): p. 462-467. [3]Woolf, C.J., Central sensitization: implications for the diagnosis and treatment of pain. Pain, 2011. 152(3 Suppl): p. S2-s15. [4]Nijs, J., et al., Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain. Pain Physician, 2014. 17(5): p. 447-57. The GESPIC-AS cohort is partially financed by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung - BMBF) Fares Al Mohamad: None declared, Valeria Rios Rodriguez Speakers bureau: AbbVie, Falk e.V., Hildrun Haibel Paid instructor for: Boehringer, Janssen, MSD, Novartis, Sobi, Roche, Pfizer, AbbVie, and Sobi, Mikhail Protopopov Consultant of: Novartis, Judith Rademacher Consultant of: Novartis and UCB, Joachim Sieper Speakers bureau: Abbvie, Janssen, Lilly, Merck, Novartis, UCB, Consultant of: AbbVie, Lilly, Merck, Novartis, UCB, Murat Torgutalp: None declared, Henriette Käding: None declared, Fabian Proft Speakers bureau: AMGEN, AbbVie, BMS, Celgene, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer Inc and UCB, Consultant of: AbbVie, BIOCAD, Gilead Sciences, GlaxoSmithKline, Eli Lilly, MSD, Novartis, Pfizer Inc, Samsung Bioepis and UCB, Grant/research support from: AbbVie, MSD, Novartis and Pfizer. Table 1Baseline characteristics.Characteristicn = 70Female sex49(70)Age, years37.27±10.77HLA-B27 positive64(91.4)BMI, kg/m²25.57±4.49Current smokers28(40)Symptom duration, years12.53±10.83Elevated CRP, >5 mg/l43(61.4)ASDAS-CRP3.41±0.82current NSAIDs intake56(80)Data are expressed as n(%) or mean ± standard deviation, BMI: Body mass index, CRP: C-reactive protein, ASDAS-CRP: Ankylosing Spondylitis Disease Activity Score – C-reactive protein, NSAIDs: Nonsteroidal anti-inflammatory drugsThe mean (±SD) bDMARD treatment duration was 2.79 ± 1.40 (range: 0.27 – 5.01) years at the time point of PD and WPI measurement. Higher PD and WPI scores at follow up showed a significant association with higher ASDAS-CRP scores in a multiple linear regression model. This was also true for age, HLA-B27 and the CRP level at follow-up. Logistic regression analysis showed that a high PD score and a high WPI score were also associated with higher odds of having high/ very high disease activity (ASDAS >2.1) independently of other factors including elevated CRP.

• Publisher: Elsevier B.V,Elsevier Limited
• Subject: Ankylosing spondylitis / Arthritis / bDMARD / Body mass index / C-reactive protein / Chronic pain / Disease / Histocompatibility antigen HLA / Inflammation / Inflammatory diseases / Interleukin 17 / Low back pain / Nervous system / Neuralgia / Nonsteroidal anti-inflammatory drugs / Pain / Patients / Proteins / Regression analysis / Rheumatic diseases / Spondyloarthritis