Background: Pain in rheumatic diseases (RD) is primarily due to mechanical or inflammatory mechanism, but neuropathic pain (NP) component is yet to be fully evaluated and described, with a particular attention to the distinction with nociceptive pain .
Objectives: The aim of our study was to assess the prevalence of migraine and neuropathic pain in patients with RD and to explore factors associated with NP.
Methods: Prospective study including patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) were invited to complete a validated self-assessment questionnaires. Sociodemographic data as well as disease related characteristics were recorded. Migraine was diagnosed according to the IHS migraine diagnostic criteria. NP was evaluated using DN4 (Douleur Neuropathique 4 Questions) and Pain DETECT questionnaire (PDQ). Neuropathic pain was retained in case of a total score of 4 or more at DN4-interview questionnaire or a score ≥19 with the PDQ.
Results: A total of 60 patients with RD were included (42 RA/18 SpA). Females outnumbered males (sex-ratio=1.7). The mean age was 51.3 ± 13.1 years [18-75] and the mean disease duration was 11.9 ±5.6 [1-23] years. The prevalence of migraine was 15%. This latter was higher among women than men and among RA patients than SpA (18% vs 9%, 16.6% vs 11.2%) with no statistically significant correlation (p=0,329, 0,581 respectively). Parameters associated with a higher prevalence of migraine were an older age (p=0,042). However, there was no correlation between the presence of migraine and the type of the RD, disease duration or the level of anxiety (p=0,059, p=0,459 respectively). Chronic pain with neuropathic characteristics was found in 21.7% with the DECT score and 16.7% with DN4 questionnaire. NP was most prevalent among patients with comorbidities (28.5% vs 6%, p=0.021) and with higher body mass index (p=0.01). Prevalence was significantly higher in the RA group (19%) than in the SpA group (11%) without a statistically significant correlation (p=0.45). Similarly, NP was not associated with Salazopyrine intake (p=0.9).
Conclusion: We found a high prevalence of migraine and NP in our sample of patients with RD. It seems therefore important to check the presence of migraine or NP especially in patients with comorbidities and older ones.
References: Bailly F, Cantagrel A, Bertin P, et al. Part of pain labelled neuropathic in rheumatic disease might be rather nociplastic. RMD Open. 2020;6:e001326.
Disclosure of Interests: None declared
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