Categories
Change Password!
Reset Password!
Central sensitization independently drives pain, poor sleep, and symptom burden in rheumatoid and psoriatic arthritis, regardless of inflammatory activity.
A new cross-sectional study suggests that central sensitization (CS) is a major contributor to symptom burden in rheumatoid arthritis (RA) and psoriatic arthritis (PsA), with its impact extending beyond inflammatory disease activity. These findings highlight the importance of assessing altered pain processing alongside conventional measures of inflammation to better identify those with persistent symptoms.
The study, led by Gamze Dilek et al., enrolled 185 patients attending a rheumatology outpatient clinic, including 93 patients with PsA and 92 patients with RA. Researchers assessed CS using the Central Sensitization Inventory (CSI), sleep quality with the Pittsburgh Sleep Quality Index (PSQI), and neuropathic pain-like symptoms using the painDETECT questionnaire (PDQ). Multivariable linear regression analyses were executed to determine factors independently linked with CS severity.
Overall, 48.6% of participants fulfilled the criteria for CS (CSI ≥40). Although patients with PsA had higher CSI scores than those with RA, the diagnosis itself did not independently predict CS severity after adjustment for clinical variables. Patients with CS experienced a markedly greater clinical burden, with higher tender joint counts, Disease Activity Score in 28 joints (DAS28), pain intensity, and both patient- and physician-reported global assessment scores than those without CS (all p<0.001). They also reported substantially poorer sleep quality and more prominent neuropathic pain-like symptoms, underscoring the multidimensional impact of CS.
Correlation analyses demonstrated that higher CSI scores were strongly associated with increased pain intensity, greater disease activity, higher tender joint counts, and worsening sleep quality. However, multivariable regression identified poor sleep quality as the strongest independent clinical correlate of CS (B=1.94). Fibromyalgia was also independently linked with higher CSI scores (B=11.79). In contrast, inflammatory markers, treatment modality, and arthritis subtype (RA vs. PsA) were not independently linked with CS severity.
Thus, while CS is more pronounced in patients with PsA, it develops independently of arthritis phenotype and inflammatory activity. Instead, it appears to be a key determinant of pain amplification, sleep disturbance, and overall symptom burden. The investigators conclude that incorporating multidimensional pain assessment, including screening for CS, into routine rheumatology practice may improve recognition of patients whose symptoms are driven by altered pain processing rather than ongoing inflammation. Such an approach could support more personalized management strategies and help optimize outcomes for those with inflammatory arthritis.
Rheumatology International
Central sensitization in rheumatoid arthritis and psoriatic arthritis is associated with symptom burden than inflammatory activity: a cross-sectional study
Gamze Dilek et al.
Comments (0)