Central pain mechanisms may be prominent insubsets of patients with rheumatoid arthritis(RA), psoriatic arthritis (PsA) and otherspondyloarthritis (SpA). The painDETECTquestionnaire (PDQ) identifies neuropathic painfeatures, which may act as a proxy for centrallymediated pain.The objectives were to quantify and characterizepain phenotypes (non-neuropathic vs.neuropathic features) among Danish arthritispatients using the PDQ, and to assess theassociation with on-going inflammation. Methods:
The PDQ was included onto the DANBIO touchscreens at 22 departments of Rheumatology in Denmark for six months. Clinical data andpatient reported outcomes were obtained fromDANBIO. A PDQ-score >18 indicated neuropathicpain features, 13–18 unclear pain mechanismand <13 non-neuropathic pain.
Results:Pain data (visual analogue scale, VAS) wasavailable for 15,978 patients. 7,054 patientscompleted the PDQ (RA: 3,826, PsA: 1,180, SpA:1,093). 52% of all patients and 63% of PDQ-completers had VAS pain score ≥ 30 mm. The distribution of the PDQ classification-groups(<13/ 13-18/ >18) were; RA: 56%/24%/20%.PsA: 45%/ 27%/ 28%. SpA: 55% / 24%/ 21%.More patients with PsA had PDQ score >18 compared to RA and SpA (p<0.001). For PDQ >18 significantly higher scores were found for allpatient reported outcomes and disease activityscores. No clinical difference in CRP or swollenjoint count was found. Logistic regressionshowed increased odds for having VAS pain ≥39
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mm (the median) for a PDQ-score >18compared to <13 (OR = 10.4; 95%CI 8.6–12.5). Conclusions: More than 50% of the Danish arthritis patientsreported clinically significant pain. More than20% of the PDQ-completers had indication ofneuropathic pain features, which was related toa high pain-level. PDQ-score was associated withDAS28-CRP and VAS pain but not with indicatorsof peripheral inflammation (CRP and SJC). Thus,pain classification by PDQ may assist inmechanism-based pain treatment.