The Utility of the Central Sensitivity Score as a Predictor of Disease Activity in a Cohort of Stable Rheumatoid Arthritis
Main Article Content
Abstract
Objective: To assess the impact of central sensitisation as measured by the ‘Central Sensitivity Score’ on rheumatoid arthritis disease activity change.
Methods: This was a prospective cohort study of rheumatoid arthritis patients receiving routine clinical care. At baseline, participants had assessment of rheumatoid arthritis disease activity from a 3-variable Disease Activity Score with 28 Joint Count Erythrocyte Sedimentation Rate, symptoms of central sensitisation (from central sensitivity score, the numerical score derived from the 2016 American College of Rheumatology Fibromyalgia diagnostic criteria), demographic and clinical variables. A follow up 3-variable Disease Activity Score with 28 Joint Count Erythrocyte Sedimentation Rate was collected on the next routine clinic appointment (median 3 months). The association of central sensitivity score and change in rheumatoid arthritis disease activity was assessed using a multivariate linear regression analysis.
Results: Data were obtained from 82 participants. The median baseline 3-variable Disease Activity Score with 28 Joint Count Erythrocyte Sedimentation Rate across the cohort was 2.44. On multivariate linear regression a higher baseline central sensitivity score independently predicted improvement in 3-variable Disease Activity Score with 28 Joint Count Erythrocyte Sedimentation Rate (regression coefficient=-0.02, 95% CI [-0.08 to -0.01]). A higher C-Reactive Protein was also an independent predictor of improvement in 3-variable Disease Activity Score with 28 Joint Count Erythrocyte Sedimentation Rate (regression coefficient -0.02, 95% CI [-0.04 to 0.01]). Exposure to a higher number of biologics predicted worsening in 3-variable Disease Activity Score with 28 Joint Count Erythrocyte Sedimentation Rate (regression coefficient=0.28, 95% CI [0.08 to 0.48]).
Conclusion: In this closely monitored cohort with relatively well controlled disease, a higher baseline central sensitivity score was predictive of a small but not clinically meaningful change in objective rheumatoid arthritis disease activity.
Keywords:
Arthritis, Rheumatoid, Central Nervous System Sensitization, Prognosis, Fibromyalgia, Surveys and Questionnaires
Article Details
How to Cite
MEZHOV, Veronica et al.
The Utility of the Central Sensitivity Score as a Predictor of Disease Activity in a Cohort of Stable Rheumatoid Arthritis.
Medical Research Archives, [S.l.], v. 11, n. 11, nov. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4665>. Date accessed: 16 may 2024.
doi: https://doi.org/10.18103/mra.v11i11.4665.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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34. Ranzolin A, Brenol JCT, Bredemeier M, et al. Association of concomitant fibromyalgia with worse disease activity score in 28 joints, health assessment questionnaire, and short form 36 scores in patients with rheumatoid arthritis. Arthritis Rheum 2009;61:794-800.
35. Azarfar A, Ahmed A, Beg S. Prevalence of anxiety, depression, sleep disturbance, fibromyalgia, obesity, and gastroesophageal disease in patients with rheumatic diseases. Curr Rheumatol Rev 2021;17:252-7.
36. Wolfe F, Michaud K, Busch RE, et al. Polysymptomatic distress in patients with rheumatoid arthritis: Understanding disproportionate response and its spectrum. Arthritis Care Res 2014;66:1465-71.
37. Moore MN, Wallace BI, Song J, et al. Correlation of fibromyalgia survey questionnaire and quantitative sensory testing among patients with active rheumatoid arthritis. J Rheumatol 2022;49:1052.
38. Gorzewski AM, Heisler AC, Neogi T, et al. Predicting disease activity in rheumatoid arthritis with the fibromyalgia survey questionnaire: Does the severity of fibromyalgia symptoms matter? J Rheumatol 2022 Dec 16 (Epub ahead of print).
39. McWilliams DF, Kiely PDW, Young A, et al. Interpretation of das28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis. BMC Rheumatol 2018;2:8.
40. McWilliams DF, Zhang W, Mansell JS, et al. Predictors of change in bodily pain in early rheumatoid arthritis: An inception cohort study. Arthritis Care Res (Hoboken) 2012;64:1505-13.
41. Harte SE, Harris RE, Clauw DJ. The neurobiology of central sensitization. J Appl Biobehav Res 2018;23:e12137.
42. Leu Agelii M, Andersson M, Jones BL, et al. Disease activity trajectories in rheumatoid arthritis: A tool for prediction of outcome. Scand J Rheumatol 2021;50:1-10.
43. Nikiphorou E, Radner H, Chatzidionysiou K, et al. Patient global assessment in measuring disease activity in rheumatoid arthritis: A review of the literature. Arthritis Res Ther 2016;18:251.
44. Ferreira RJO, Welsing PMJ, Jacobs JWG, et al. Reexamining remission definitions in rheumatoid arthritis: Considering the 28-joint disease activity score, c-reactive protein level, and patient global assessment: Comment on the article by felson et al. Arthritis Care Res 2022;74:501-2.
45. Ferreira RJO, Welsing PMJ, Jacobs JWG, et al. Revisiting the use of remission criteria for rheumatoid arthritis by excluding patient global assessment: An individual meta-analysis of 5792 patients. Ann Rheum Dis 2021;80:293.
46. Bugatti S, De Stefano L, D’Onofrio B, et al. Inflammatory correlates of the patient global assessment of disease activity vary in relation to disease duration and autoantibody status in patients with rheumatoid arthritis. Ann Rheum Dis 2022;81:1206-13.
47. Pope JE, Choy EH. C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Semin Arthritis Rheum 2021;51:219-29.
48. Katchamart W, Johnson S, Lin H-JL, et al. Predictors for remission in rheumatoid arthritis patients: A systematic review. Arthritis Care Res 2010;62:1128-43.
49. Lequerre T, Rottenberg P, Derambure C, Cosette P, Vittecoq O. Predictors of treatment response in rheumatoid arthritis. Joint bone spine 2019;86:151-8.
50. Nagy G, Roodenrijs NMT, Welsing PMJ, et al. Eular points to consider for the management of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2022;81:20-33.
2. Smolen JS, Landewe R, Breedveld FC, et al. Eular recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 2014;73:492-509.
3. Lee YC, Cui J, Lu B, et al. Pain persists in das28 rheumatoid arthritis remission but not in acr/eular remission: A longitudinal observational study. Arthritis Res Ther 2011;13:R83.
4. Roodenrijs NMT, van der Goes MC, Welsing PMJ, et al. Difficult-to-treat rheumatoid arthritis: Contributing factors and burden of disease. Rheumatology (Oxford) 2021;60:3778-88.
5. Nagy G, Roodenrijs NM, Welsing PM, et al. Eular definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021;80:31-5.
6. Walsh DA, McWilliams DF. Mechanisms, impact and management of pain in rheumatoid arthritis. Nat Rev Rheumatol 2014;10:581-92.
7. Meeus M, Vervisch S, De Clerck LS, et al. Central sensitization in patients with rheumatoid arthritis: A systematic literature review. Semin Arthritis Rheum 2012;41:556-67.
8. Heisler AC, Song J, Dunlop DD, et al. Association of pain centralization and patient-reported pain in active rheumatoid arthritis. Arthritis Care Res 2019;0.
9. Boyden SD, Hossain IN, Wohlfahrt A, Lee YC. Non-inflammatory causes of pain in patients with rheumatoid arthritis. Curr Rheumatol Rep 2016;18:30.
10. Duffield SJ, Miller N, Zhao S, Goodson NJ. Concomitant fibromyalgia complicating chronic inflammatory arthritis: A systematic review and meta-analysis. Rheumatology (Oxford) 2018;57:1453-60.
11. Joharatnam N, McWilliams DF, Wilson D, et al. A cross-sectional study of pain sensitivity, disease-activity assessment, mental health, and fibromyalgia status in rheumatoid arthritis. Arthritis Res Ther 2015;17:11.
12. Lee YC, Bingham CO, 3rd, Edwards RR, et al. Association between pain sensitization and disease activity in patients with rheumatoid arthritis: A cross-sectional study. Arthritis Care Res 2018;70:197-204.
13. Ten Klooster PM, de Graaf N, Vonkeman HE. Association between pain phenotype and disease activity in rheumatoid arthritis patients: A non-interventional, longitudinal cohort study. Arthritis Res Ther 2019;21:257.
14. Shresher NM, Mohamed AE, Elshahaly MH. Performance of 2016 revised fibromyalgia diagnostic criteria in patients with rheumatoid arthritis. Rheumatol Int 2019;39:1703-10.
15. Salaffi F, Gerardi MC, Atzeni F, et al. The influence of fibromyalgia on achieving remission in patients with long-standing rheumatoid arthritis. Rheumatol Int 2017;37:2035-42.
16. Provan SA, Austad C, Halsaa V, et al. Fibromyalgia in patients with rheumatoid arthritis. A 10-year follow-up study, results from the oslo rheumatoid arthritis register. Clin Exp Rheumatol 2019;37 Suppl 116:58-62.
17. Andersson MLE, Svensson B, Bergman S. Chronic widespread pain in patients with rheumatoid arthritis and the relation between pain and disease activity measures over the first 5 years. J Rheumatol 2013;40:1977-85.
18. Durmaz Y, Ilhanli I. Rheumatoid arthritis activity scores in patients with and without fibromyalgia syndrome. Ann Saudi Med 2021;41:246-52.
19. Lage-Hansen PR, Chrysidis S, Lage-Hansen M, et al. Concomitant fibromyalgia in rheumatoid arthritis is associated with the more frequent use of biological therapy: A cross-sectional study. Scand J Rheumatol 2016;45:45-8.
20. Heisler AC, Song J, Muhammad LN, et al. Association of dysregulated central pain processing and response to disease-modifying antirheumatic drug therapy in rheumatoid arthritis. Arthritis Rheumatol 2020;72:2017-24.
21. Curtis JR, Herrem C, Ndlovu MN, O'Brien C, Yazici Y. A somatization comorbidity phenotype impacts response to therapy in rheumatoid arthritis: Post-hoc results from the certolizumab pegol phase 4 predict trial. Arthritis Res Ther 2017;19:215.
22. Wolfe F, Brahler E, Hinz A, Hauser W. Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: Results from a survey of the general population. Arthritis Care Res 2013;65:777-85.
23. Littlejohn GO, Guymer EK. In clinical practice, the term "central sensitivity score" is more useful than the term "polysymptomatic distress scale": Comment on the editorial by wolfe. Arthritis Rheumatol 2015;67:2553-.
24. Wolfe F, Clauw DJ, Fitzcharles M-A, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the acr preliminary diagnostic criteria for fibromyalgia. J Rheumatol 2011;38:1113-22.
25. Fitzcharles M-A, Perrot S, Häuser W. Comorbid fibromyalgia: A qualitative review of prevalence and importance. Eur J Pain 2018;22:1565-76.
26. Williams DA. Phenotypic features of central sensitization. J Appl Biobehav Res 2018;23:e12135.
27. Wallace BI, Moore MN, Heisler AC, et al. Fibromyalgianess and glucocorticoid persistence among patients with rheumatoid arthritis. Rheumatology (Oxford) 2022;61:1556-62.
28. Kim H, Cui J, Frits M, et al. Fibromyalgia and the prediction of two-year changes in functional status in rheumatoid arthritis patients. Arthritis Care Res 2017;69:1871-7.
29. Wolfe F, Clauw DJ, Fitzcharles M-A, et al. 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016;46:319-29.
30. Wolfe F, Clauw DJ, Fitzcharles M-A, et al. The american college of rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 2010;62:600-10.
31. Anderson JK, Zimmerman L, Caplan L, Michaud K. Measures of rheumatoid arthritis disease activity: Patient (ptga) and provider (prga) global assessment of disease activity, disease activity score (das) and disease activity score with 28-joint counts (das28), simplified disease activity index (sdai), clinical disease activity index (cdai), patient activity score (pas) and patient activity score-ii (pasii), routine assessment of patient index data (rapid), rheumatoid arthritis disease activity index (radai) and rheumatoid arthritis disease activity index-5 (radai-5), chronic arthritis systemic index (casi), patient-based disease activity score with esr (pdas1) and patient-based disease activity score without esr (pdas2), and mean overall index for rheumatoid arthritis (moi-ra). Arthritis Care Res 2011;63:S14-S36.
32. Harris PA, Taylor R, Minor BL, et al. The redcap consortium: Building an international community of software platform partners. J Biomed Inform 2019;95:103208.
33. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (redcap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377-81.
34. Ranzolin A, Brenol JCT, Bredemeier M, et al. Association of concomitant fibromyalgia with worse disease activity score in 28 joints, health assessment questionnaire, and short form 36 scores in patients with rheumatoid arthritis. Arthritis Rheum 2009;61:794-800.
35. Azarfar A, Ahmed A, Beg S. Prevalence of anxiety, depression, sleep disturbance, fibromyalgia, obesity, and gastroesophageal disease in patients with rheumatic diseases. Curr Rheumatol Rev 2021;17:252-7.
36. Wolfe F, Michaud K, Busch RE, et al. Polysymptomatic distress in patients with rheumatoid arthritis: Understanding disproportionate response and its spectrum. Arthritis Care Res 2014;66:1465-71.
37. Moore MN, Wallace BI, Song J, et al. Correlation of fibromyalgia survey questionnaire and quantitative sensory testing among patients with active rheumatoid arthritis. J Rheumatol 2022;49:1052.
38. Gorzewski AM, Heisler AC, Neogi T, et al. Predicting disease activity in rheumatoid arthritis with the fibromyalgia survey questionnaire: Does the severity of fibromyalgia symptoms matter? J Rheumatol 2022 Dec 16 (Epub ahead of print).
39. McWilliams DF, Kiely PDW, Young A, et al. Interpretation of das28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis. BMC Rheumatol 2018;2:8.
40. McWilliams DF, Zhang W, Mansell JS, et al. Predictors of change in bodily pain in early rheumatoid arthritis: An inception cohort study. Arthritis Care Res (Hoboken) 2012;64:1505-13.
41. Harte SE, Harris RE, Clauw DJ. The neurobiology of central sensitization. J Appl Biobehav Res 2018;23:e12137.
42. Leu Agelii M, Andersson M, Jones BL, et al. Disease activity trajectories in rheumatoid arthritis: A tool for prediction of outcome. Scand J Rheumatol 2021;50:1-10.
43. Nikiphorou E, Radner H, Chatzidionysiou K, et al. Patient global assessment in measuring disease activity in rheumatoid arthritis: A review of the literature. Arthritis Res Ther 2016;18:251.
44. Ferreira RJO, Welsing PMJ, Jacobs JWG, et al. Reexamining remission definitions in rheumatoid arthritis: Considering the 28-joint disease activity score, c-reactive protein level, and patient global assessment: Comment on the article by felson et al. Arthritis Care Res 2022;74:501-2.
45. Ferreira RJO, Welsing PMJ, Jacobs JWG, et al. Revisiting the use of remission criteria for rheumatoid arthritis by excluding patient global assessment: An individual meta-analysis of 5792 patients. Ann Rheum Dis 2021;80:293.
46. Bugatti S, De Stefano L, D’Onofrio B, et al. Inflammatory correlates of the patient global assessment of disease activity vary in relation to disease duration and autoantibody status in patients with rheumatoid arthritis. Ann Rheum Dis 2022;81:1206-13.
47. Pope JE, Choy EH. C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Semin Arthritis Rheum 2021;51:219-29.
48. Katchamart W, Johnson S, Lin H-JL, et al. Predictors for remission in rheumatoid arthritis patients: A systematic review. Arthritis Care Res 2010;62:1128-43.
49. Lequerre T, Rottenberg P, Derambure C, Cosette P, Vittecoq O. Predictors of treatment response in rheumatoid arthritis. Joint bone spine 2019;86:151-8.
50. Nagy G, Roodenrijs NMT, Welsing PMJ, et al. Eular points to consider for the management of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2022;81:20-33.