Ankilozan Spondilitli Hastalarda Nöropatik Ağrının Hastalık Aktivite Skorları İle İlişkisi ve Anti-TNFα Kullanımının Etkisi

Yıl 2021, Cilt: 54 Sayı: 1, 43 - 47, 27.04.2021

Gezmiş Kimyon Ümran Gezici Meryem Gümüşay Mehmet Karadağ Feyyaz Bay İsmet Melek

https://doi.org/10.20492/aeahtd.819435

Öz

Amaç: Bu çalışmada ankilozan spondiliti olan hastalarda nöropatik ağrının hastalık aktivite indekslerine etki edip etmediği ve aynı zamanda tedavide kullanılan anti-TNFα gibi ajanların bununla ilişkili olup olmadığını araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmaya modifiye New York kriterlerine göre ankilozan spondilit tanıs konan 98 hasta ve yaş ve cinsiyet uyumlu 99 sağlıklı kontrol alındı. Her iki grupta nöropatik ağrı painDETECT skorlamasına göre yapıldı. Ankilozan spondilit hastalarının hastalık aktiviteleri BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), BASFI (Bath ankylosing spondylitis functional ındex), VAS ağrı (Visual Analog Scale) ve Leeds entezit indeksi ile değerlendirildi. Ayrıca her iki gruba HAQ (Health Assesment Questionnaire) ve Beck depresyon ölçeği uygulandı. Ayrıca ankilozan spondilit hastaları anti-TNFα ilaç kullanan ve kullanmayan şeklinde iki grup olarak karşılaştırıldı.
Bulgular: PainDETECT hasta grubunda kontrol grubuna göre istatistiksel olarak anlamlı derecede yüksekti. Ankilozan spondilit grubunda ortalama painDETECT 22,1 kontrol grubunda ise 9,95 idi (p<0,001). Hasta grubunda VAS, HAQ ve Beck depresyon ölçeği kontrol grubuna göre istatistiksel olarak anlamlı derecede yüksek saptandı. Anlilozan spondilit hastaları anti-TNFα ilaç kullanan ve kullanmayan olarak incelendiğinde painDETECT ile anti-TNFα kullanmak arasında istatistiksel anlamlı bir fark saptanmadı. Anti-TNFα kullanan grupta painDETECET ortalama 20,3 kullanmayan grupta 17,8 (p=0,135) idi. Kolerasyon analizi yapıldığında ise painDETECT ile BASDAI, VAS ağrı ve Beck depresyon ölçeği arasında orta düzeyde pozitif yönde kolerasyon saptandı.
Sonuç: Ankilozan spondilitte nöropatik ağrı hastalık aktivite göstergeleri ile paralellik gösterir. Dolayısıyla yüksek hastalık aktivitesine sahip hastalarda nöropatik ağrı mevcutsa aşırı tedavinin önüne geçebilir. Anti-TNFα ilaçlar ile nöropatik ağrı arasında herhangi bir ilişki saptamadık.

Anahtar Kelimeler

Ankilozan spondilit, nöropatik ağrı, anti-TNFα

The Relationship of Neuropathic Pain with Disease Activity Scores in Patients with Ankylosing Spondylitis and the Effect of Anti-TNFα Use

Öz

Aim: In this study, we aimed to investigate whether neuropathic pain affects disease activity indexes in patients with ankylosing spondylitis and also whether agents such as anti-TNFα are associated with it.
Material and Method: Ninety-eight patients diagnosed with ankylosing spondylitis according to the modified New York criteria and 99 age and gender matched healthy controls were included in the study. Neuropathic pain in both groups was determined according to painDETECT scoring. Disease activities of patients with ankylosing spondylitis were evaluated with BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), BASFI (Bath ankylosing spondylitis functional index), VAS pain (Visual Analog Scale) and Leeds enthesitis index. In addition, HAQ (Health Assesment Questionnaire) and Beck depression scales were applied to both groups. In addition, patients with ankylosing spondylitis were compared in two groups, using anti-TNFα drugs and those who did not.
Results: PainDETECT was statistically significantly higher in the patient group compared to the control group. Mean painDETECT was 22.1 in the ankylosing spondylitis group and 9.95 in the control group (p <0.001). In the patient group, VAS, HAQ and Beck depression scale were found to be statistically significantly higher than the control group. When the patients with anlilosing spondylitis were examined with and without anti-TNFα drugs, no statistically significant difference was found between painDETECT and anti-TNFα use. The mean painDETECET was 20.3 in the group using anti-TNFα and 17.8 (p = 0.135) in the group not using. When correlation analysis was performed, a moderate positive correlation was found between painDETECT and BASDAI, VAS pain and Beck depression scale.
Conclusion: Neuropathic pain in ankylosing spondylitis parallels the disease activity indicators. Therefore, if neuropathic pain is present in patients with high disease activity, overtreatment can be prevented. We did not find any relationship between anti-TNFα drugs and neuropathic pain.

Anahtar Kelimeler

Ankylosing spondylitis, neuropathic pain, anti-TNFα

Kaynakça

• 1. Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007 Apr 21;369(9570):1379-1390.
• 2. Haanpaa M, Attal N, Backonja M et al. NeuPSIG guidelines on neuropathic pain assesment. Pain. 2011 Jan;152(1):14-27.
• 3. Garrett S, Jenkinson T, Kennedy LG et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994 Dec;21(12):2286-91.
• 4. Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984;27:361-368.
• 5. Karatepe AG, Akkoc Y, Akar S et al. The Turkish versions of the Bath Ankylosing Spondylitis and Dougados Functional Indices: reliability and validity. Rheumatol Int 2005;25:612-618.
• 6. Healy PJ, Helliwell PS. Measuring clinical enthesitis in psoriatic arthritis: assesment of existing measures and development of an instrument spesific to psoriatic arthritis. Arthritis Rheum. 2008 May 15;59(5):686-91.
• 7. Alkan H, Ardic F, Erdogan C et al. Turkish version of the painDETECT questionnaire in the assessment of neuropathic pain: a validity and reliability study. Pain Med 2013;14:1933-1943.
• 8. Wu Q, Inman RD, Davis KD. Neuropathic pain in ankylosing spondylitis: a psychophysics and brain imaging study. Arthritis Rheum. 2013 Jun;65(6):1494-503.
• 9. Truini A, Padua L, Biasiotta A et al. Differential involvement of A-delta and A-beta fibres in neuropathic pain related to carpal tunnel syndrome. Pain. 2009 Sep;145(1-2):10-9.
• 10. Truini A,Galeotti F, Haanpaa M et al. Pathophysiology of pain in postherpetic neuralgia: a clinical and neurophysiological study. Pain. 2008 Dec;140(3):405-10.
• 11. Choi JH, Lee SH, Kim HR et al. Association of neuropathic-like pain characterisics with clinical and radiographic features in patients with ankylosing spondylitis. Clin Rheumatol. 2018 Nov;37(11):3077-3086.
• 12. Geler-Külcü D, Batıbay S, Öztürk G et al. The association of neuropathic pain and disease activity, functional level, and quality of life in patients with ankylosing spondylitis: a cross-sectional study. Turk J Med Sci. 2018 Apr 30;48(2):257-265.
• 13. Kim TW, Son SM, Lee JS. Neuropathic pain in ankylosing spondylitis: a meta-analysis. Z Rheumatol. 2020 Feb;79(1):95-102.
• 14. Wu Q, Inman RD, Davis KD. Tumor necrosis factor inhibitor therapy in ankylosing spondylitis: differential effects on pain and fatigue and brain correlates. Pain. 2015 Feb;156(2):297-304.