K.R. ZAGRETDINOVA¹, A.R. GARAEVA¹, Z.N. GABDULLINA², E.S. ZAMANOVA², E.V. SUKHORUKOVA², R.Z. ABDRAKIPOV², S.A. LAPSHINA¹

¹Kazan State Medical University, Kazan

²Republic Clinical Hospital, Kazan

  Contact details:

Zagretdinova K.R. — resident physician of the Department of Hospital Therapy

Address: 49 Butlerov St., Kazan, Russian Federation, 420012, tel.: +7-919-643-51-93, e-mail: karina_shaporeva@mail.ru

 The purpose — to evaluate the nature of pain syndrome in patients with ankylosing spondylitis (AS) in correlation with the course of the disease.

Material and methods. 76 patients with a verified diagnosis of AS were examined. Men accounted for 60.5% of the patients, women — 39.5%. The mean age in the studied group of patients was 42 [34.25; 58.75] years. Disease activity was assessed by ASDAS-CRP, median 4.05 [2.91; 4.7]. The mean disease duration was 138 [96; 261] months. To assess the multicomponent of chronic pain, the following were used: neuropathic pain (NP) questionnaire — Pain Detect, Central Sensitisation Inventory scale to assess the relationship of pain with central sensitization (CS), EQ-5D and SF-36 questionnaires to assess the quality of life.

Results. In the studied cohort of patients, only 10.5% had isolated inflammatory pain, all others had mixed pain. Three-component pain occurred in 52.8% of cases. Patients with mixed pain were older in age, had higher disease activity according to ASDAS-CRP, had radiological stage 3–4 and reduced quality of life according to EQ-5D-3L and SF-36 questionnaire. NP in patients with AS was significantly dependent on the presence and severity of peripheral arthritis (r = 0.468, p < 0.001), the level of ESR (r = 0.552, p < 0.001) and circulating immune complexes (r = 0.464, p = 0,005). CS was associated with greater pain intensity by VAS (r = 0.610, p < 0.001), was dependent on inflammatory markers — CRP (r = 0.451, p = 0.004), influenced quality of life by EQ-5D (r = — 0.681, p < 0.001) and SF-36 (physical comp r = -0.579, p < 0.001, mental comp r = -0.587, p < 0.001) questionnaires.

Conclusions. In 89.5% of the studied patients with AS, the chronic pain syndrome was mixed in nature, with CS predominating over NP. Patients with AS and presence of several types of pain had higher clinical and laboratory activity of the disease and X-ray stage, peripheral arthritis was more frequent.

Key words: ankylosing spondylitis, inflammatory pain, neuropathic pain, central sensitization.

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