Diz osteoartritinde radyolojik evrelemenin nöropatik ağrı ve santral sensitizasyon ile ilişkisi

Abstract

Giriş ve Amaç:Osteoartrit (OA), en sık görülen eklem hastalığıdır ve kişinin günlükyaşam aktivitelerini ve sosyal performansını önemli ölçüde bozan bir morbiditenedenidir. Kronik romatizmal pek çok hastalıkta uzun dönemde ağrının kronisitegöstermesi hastalık kontrol altına alındığı dönemlerde bile ağrının devam etmesi bizealtta yatan başka mekanizmaları düşündürmektedir. Nöropatik ağrı, santralsensitizasyon (SS) ve sendromları kronik romatizmal hastalıklara sıklıkla eşliketmektedir. Bu çalışmadaki amacımız diz OA olan hastalarda nöropatik ağrı ve SSvarlığını araştırmak ve bunun hastalık şiddeti ve radyolojik evre ile ilişkisinigöstermektir.Gereç ve Yöntem: Çalışma prospektif tanımlayıcı olan planlandı. Çalışmaya TıpFakültesi Hastanesi Fiziksel Tıp ve Rehabilitasyon polikliniğine başvuran 79 hasta dahiledildi. Hastaların yaş, cinsiyet, vücut kitle indeksi (VKİ) kaydedildi. Osteoartritradyolojik evrelemesi için Kellgren Lawrance (KL) evreleme sistemi, ağrı varlığıWestern Ontario ve McMaster Universitesi Artrit İndex (WOMAC), nöropatik ağrıvarlığı Nöropatik Semptom ve Bulguların Özdeğerlendirimi (S-LANSS) ve santralsensitizasyon Santral Sensitizasyon Envanteri (SSE) ile değerlendirildi.Bulgular: Katılımcıların (N=79) 44'ünde (%55.7) nöropatik ağrı, 67'sinde (%84.8)santral sensitizasyon gözlendi. Katılan 79 hastanın 70'i kadın (%88.6), 9'u (%11.4)erkek cinsiyette idi. Hastaların yaş ortalaması 56.45±7.07 yıl ve VKİ 32.83±5.54 kg/m2idi. Kellgren Lawrence evrelemesine göre evre-1 hasta sayısı 1 (%1.3), evre-2 hastasayısı 25 (%31.6), evre-3 hasta sayısı 40 (%50.6), evre-4 hasta sayısı 13 (%16.5)bulunmuştur. Grubu KL evresine göre; KL ileri (evre 3-4) ve düşük (evre 1-2) evre olaraksınıfladığımızda ileri evre olan grup daha ileri yaşta idi (P=0.00). VKİ'leri benzerdi(P=0.56). S-LANSS skorları her iki grupta da benzer idi (P=0.17). WOMAC skorlarıKL evreleri yüksek olan hastalarda anlamlı olarak daha yüksekti (P=0.01).Nöropatik ağrı tanısı konan hastalarda WOMAC (P=0.00) ve SSE skoru(P=0.00) anlamlı olarak yüksek bulunmuştur. Tüm grupta S_LANNSS skoru; WOMAC(rho=0.348; P=0.002) ve SSE skoru (rho=0.483; P=0.000) ile pozitif korele idi. SSEskor WOMAC (rho=0.417; P=0.000) ve TKS (rho=0.277; P=0.014) ile pozitif koreleidi.Sonuç: Diz OA olan hastalarda nöropatik ağrı ve santral sensitizasyon radyolojik evreve hastalık şiddeti ile korele olarak sıklıkla hastalara eşlik etmektedir. Bu hastalardanöropatik ağrı ve santral sensitizasyon varlığı yaşam kalitesini olumsuz etkiler. Bunedenle hastalığın takibinde nöropatik ağrı ve santral sensitizasyonun göz önünealınması gereklidir.Anahtar Kelimeler: osteoartrit, santral sensitizasyon, nöropatik ağrı, kronik ağrı

Background and Aim: Osteoarthritis (OA) is the most common joint disease and is acause of morbidity which significantly impairs the person's daily activities and socialperformance. In chronic rheumatic diseases, the long-term pain chronicity and thecontinuation of the pain even in the period when the disease is controlled is suggestiveof other underlying mechanisms. Neuropathic pain, central sensitization (CS) andsyndromes are frequently associated with chronic rheumatic diseases. The aim of thisstudy was to investigate the presence of neuropathic pain and CS in patients with kneeOA and to demonstrate its relationship with disease severity and radiological stage.Materials and Methods: The study was planned as a prospective descriptive. Thestudy included 79 patients who were admitted to the Faculty of Medicine, Hospital ofPhysical Medicine and Rehabilitation outpatient clinic. Age, gender, body mass index(BMI) of the patients were recorded. Kellgren Lawrance (KL) staging system was usedfor osteoarthritis staging, presence of pain was evaluated by Western Ontario andMcMaster University Arthritis Index (WOMAC), presence of neuropathic pain withSelf-Assessment of Neuropathic Symptoms and Signs (S-LANSS) and centralsensitization with Central Sensitization Inventory (CSE).Results: Neuropathic pain was observed in 44 (55.7%) of the participants and centralsensitization was observed in 67 (84.8%) of the participants. Of the 79 patients, 70 werefemale (88.6%) and 9 (11.4%) were male. The mean age of the patients was 56.45 ±7.07 years and the BMI was 32.83 ± 5.54 kg / m2. According to the Kellgren Lawrencestaging, 1 (1.3%) of the stage-1 patients, 25 (31.6%) of the stage-2 patients, 40 (50.6%)of the stage-3 patients, and 13 (16.5%) of the stage-4 patients were found. According to IXKL stage; when we classified KL as advanced (stage 3-4) and low (stage 1-2) stage, theadvanced stage group was at an older age (P = 0.00). BMI was similar (P = 0.56). SLANSS scores were similar in both groups (P = 0.17). WOMAC scores weresignificantly higher in patients with higher KL stages (P = 0.01). WOMAC (P = 0.00)and CSE score (P = 0.00) were significantly higher in patients with neuropathic pain. Inthe whole group, S_LANNSS score; WOMAC (rho = 0.348; P = 0.002) and CSE score(rho = 0.483; P = 0.000) were positively correlated. The CSE score was positivelycorrelated with WOMAC (rho = 0.417; P = 0.000) and TKS (rho = 0.277; P = 0.014). WOMAC (P = 0.00) and SSE score (P = 0.00) were significantly higher inpatients with neuropathic pain. According to CL stage; The patients with advancedstage of KL (stage 3-4) and low (stage 1-2) were in advanced age group (P = 0.00). BMIwas similar (P = 0.56). S-LANSS scores were similar in both groups (P = 0.17).WOMAC scores were significantly higher in patients with higher KL stages (P = 0.01).In this group, S-LANNSS; WOMAC (rho = 0.348; P = 0.002) (Figure 2) was positivelycorrelated with SSE score (rho = 0.483; P = 0.000). The SSE score was positivelycorrelated with WOMAC (rho = 0.417; P = 0.000), TKS (rho = 0.277; P = 0.014). TSSand WOMAC (rho = 0.378; P = 0.001) were positively correlated (Table 9). The SLANSS and WOMAC scores were found to be higher in women compared to the KLstage when we divided the group into two groups. SSE score (P = 0.00) and BMI (P =0.02) were significantly higher in women.Conclusion: Neuropathic pain and CS are frequently associated with radiological stageand disease severity in patients with knee OA. The presence of neuropathic pain and CSin these patients adversely affects quality of life. For this reason, neuropathic pain andcentral sensitization should be considered in the follow-up of the disease.Keywords: osteoarthritis, central sensitization, neuropathic pain, chronic pain