Some axSpA Patients Can Relate Pain to Inflammation

Most patients with axial spondyloarthritis (axSpA) could not say whether their pain was related to inflammation or to damage in their spine and joints, but those who could were in alignment with imaging and clinical assessments, according to a study published online ahead of print in Arthritis Care & Research. 

The study included 688 patients with axSpA, of whom 24% had nonradiographic axSpA (nr-axSpA). During an outpatient clinic visit that referenced their reply to question 2 on Bath Ankylosing Spondylitis Disease Activity Index regarding their overall level of ankylosing spondylitis neck, back, or hip pain, patients were asked a follow-up question: To what extent do you think the pain you experience is related to (1) inflammation caused by axSpA? (2) damage of the spine and joints caused by axSpA?

According to the findings, 75% of patients were unable to differentiate the origin of their pain. Among patients who could, 15% said their neck, back, and hip pain was primarily related to inflammation, and 10% said it was related to structural damage of the spine and joints.

Patients who attributed their pain to inflammation tended to be younger, with shorter symptom duration, and more frequently had nr-axSpA. They also were more likely to have elevated C-reactive protein (CRP), higher Ankylosing Spondylitis Disease Activity Score with CRP, fewer comorbidities, better spinal mobility, and less radiographic spinal damage.

“If patients were able to link axial pain to clinical inflammation or damage, it was in concordance with clinical assessments and radiographic outcome, which may be helpful in establishing the origin of pain, supporting better patient-centered treatment decisions,” wrote corresponding author Suzanne Arends, PhD, of the University Medical Centre Groningen, in the Netherlands, and study coauthors.

Reference:
Kampman A, Wink F, Paap D, et al. Patient’s perspective on axial pain in relation to inflammation and structural damage in a large cohort of axial spondyloarthritis patients. Arthritis Care Res. Published online October 2, 2023. doi:10.1002/acr.25246