Analysis of pain syndrome in patients with rheumatoid arthritis and osteoarthritis of the knee

Filatova E.S.

Scientific Research Institute of Rheumatology named after V. A. Nasonova, Moscow

Pain syndrome in rheumatoid arthritis (RA) and osteoarthritis (OA) was considered as a manifestation of a nociceptive pain. However, a number of Russian and foreign studies have shown the involvement of the central nervous system in the pathogenesis of chronic pain syndrome in RA and OA. A common mechanism that supports all types of pain in a chronic condition is central sensitization (CS) — the increased reactivity of central nociceptive neurons, finally resulting in the intensification of pain.
Aim: of the study was to assess pain in patients with RA and osteoarthritis of the knee (OAk).
Patients and Methods: all patients with RA (183 people) and OAk (89 people) were examined according to a single design. The examination included clinical-neurological, clinical-rheumatological examination, diagnosis of neuropathic pain by DN4 and Pain DETECT questionnaires, as well as the emotional-affection assessment (HADS).
Results: the study showed that in these articular pathologies the mechanisms of chronic pain syndrome had a mixed nature. In 43% of RA patients, along with the inflammation (nociceptive pain), a neuropathic component was revealed, represented by disorders of the peripheral nervous system and neuropathic descriptors. In OAk patients no pathology of the somatosensory nervous system was revealed, however, together with neuropathic descriptors, primary and secondary hyperalgesia was determined in the study of the sensitive sphere, which indicated the presence of a dysfunctional pain component in 37% of OAk patients.
Conclusion: the study of the pain phenotypes in various articular pathologies makes it possible to determine both the nociceptive component in the RA and the neuropathic and dysfunctional pain components in OAk, which opens the ways to pathogenetically-directed therapy.

Key words: rheumatoid arthritis, osteoarthrosis, ankylosing spondylitis, neuropathic pain, dysfunctional pain, central sensitization, B vitamins.
For citation: Filatova E.S. Analysis of pain syndrome in patients with rheumatoid arthritis and osteoarthritis of the knee // RMJ. 2018. № 7. P. 23–27.