类风湿关节炎疼痛合并中枢敏化的临床特征分析及影响因素研究OA

Background Central sensitization(CS)is a significant factor influencing pain in patients with rheumatoid arthritis(RA).However,the clinical characteristics and distribution of traditional Chinese medicine(TCM)syndromes related to CS remain unclear,which is frequently neglected in the management of RA pain.Objective To investigate the correlation between RA pain and CS,and to explore the clinical characteristics and influencing factors of RA combined with CS.Methods The study included 200 RA patients who visited the Department of TCM Rheumatism at China-Japan Friendship Hospital from January to September 2024.General information and laboratory test indices were collected.Pain was assessed using the Visual Analogue Score(VAS),and patients were divided into mild,moderate,and severe groups based on their VAS scores.Disease activity was assessed using Disease Activity Score derivative for 28 joints(DAS28).The Central Sensitization Inventory(CSI)was employed for scoring CS and patients were divided into two groups based on CSI scores:the RA-CS group and the RA-non-CS group(referred to as the RA-nCS group).The Health Assessment Questionnaire-Disability Index(HAQ-DI)was utilized to assess health functioning status,while TCM syndromes were evaluated according to the Guidelines of Diagnosis and Treatment of Rheumatoid Arthritis Disease and Syndrome Combination.Fatigue was measured using the Validity and Reliability of A Scale to Assess Fatigue(VAS-F).Multivariate Logistic regression analysis were used to investigate the factors influencing RA pain levels and RA-CS.Using Bootstrap internal verification concordance index(C-index)and the Hosmer-Lemeshow goodness-of-fit test,the stability and accuracy of the regression model were verified and evaluated.Results Among the 200 RA patients included,88(44.0%)were classified in the mild pain group,80(40.0%)in the moderate pain group,and 32(16.0%)in the severe pain group.There were significant differences in age,TJC28,SJC28,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),DAS28-ESR,DAS28-CRP,VAS-F,CSI scores among the three groups(P<0.05).Multivariate Logistic regressio analysis showed that DAS28-ESR(OR=3.948,95%CI=1.069-14.579,P=0.039)and CSI score(OR=1.066,95%CI=1.035-1.099,P<0.001)were independent influecing factors for RA pain.Among the 200 RA patients,57(28.5%)were in the RA-CS group and 143(71.5%)in the RA-nCS group.Compared with the RA-nCS group,RA-CS group had higher disease duration,duration of morning stiffness,patients'global assessment(PGA),VAS-F score and HAQ-DI,and lower serum ESR and tumor necrosis factor α(TNF-α)levels(P<0.05).RA-CS patients had more adverse flexion and extension,sweating,lumbar and knee weakness,liver and kidney deficiency syndrome and cold-dampness obstruction syndrome,while joint fever was less(P<0.05).Multivariate Logistic regressio analysis showed that VAS-F score increasing(OR=1.735,95%CI=1.261-2.388,P<0.001)and sweating(OR=6.593,95%CI=1.656-26.242,P=0.007)were risk factors of RA-CS,and joint fever(OR=0.242,95%CI=0.067-0.872,P=0.030)was protective factors of RA-CS.The bootstrap method validation demonstrated good model consistency,while the Hosmer-Lemeshow goodness-of-fit test confirmed adequate model fit(χ2=9.532,P=0.299).Conclusion The pain of RA patients is closely related to CS.When patients show obvious fatigue and sweating without joint fever,it is essential to evaluate CS and implement a multidimensional pain management approach.