CLINICAL SIGNIFICANCE Of CENTRAL SENSITIZATION IN PATIENTS WITH RHEUMATOID ARTHRITIS

Bombela V.O., Stanislavchuk M.A.

• National Pirogov Memorial Medical University, Vinnytsia

Summary. Central sensitization (CS) is an important phenomenon that influences the clinical course and prognosis of rheumatoid arthritis (RA). Aim: to assess the clinical significance of CS in patients with RA. Materials and methods. 168 patients with RA were examined. RA activity was determined using the DAS-28, SDAI, CDAI indices. Functional capacity in patients was assessed using the Health Assessment Questionnaire (HAQ). The general health of patients was assessed using the visual analogue scale (VAS) (according to patient assessment — VAS-p and according to physician assessment — VAS-d). CS was assessed using the validated and cross-culturally adapted Ukrainian version of the Central Sensitization Inventory (CSI). Results. The prevalence of CS in patients with RA was 36.9%. Patients with CS were characterized by an older age on average 57.75±11.13 vs. 50.71±13.4 (p<0.01) and a longer duration of the disease: 12.42±9.42 vs. 6.6±6.11 years (p<0.01) than patients without CS. It was found that patients with CS had more severe stages of RA: III and IV radiological stages were more frequently observed in patients with existing CS (46.8% vs. 18.8%), while in patients without CS, I and II radiological stages predominated (81.2% vs. 53.2%). It was found that patients with CS are characterized by higher RA activity: erythrocyte sedimentation rate (ESR) — 30.08±13.73 versus 22.5±15.26 mm/h (p<0.01), DAS-28 — 6.27±0.78 versus 5.11±1.03 points (p<0.01), SDAI — 38.34±9.37 versus 27.53±9.6 points (p<0.01), CDAI — 37.56±8.99 versus 26.76±9.0 points (p<0.01), worse overall assessment of patients’ health status according to VAS-p — 7.58±1.05 versus 5.93±1.42 points (p<0.01) and VAS-d — 6.4±1.09 vs. 5.18±1.2 points (p<0.01), worse functional capacity according to HAQ — 1.79±0.58 vs. 0.86±0.57 points (p<0.01). Correlation analysis showed the presence of significant direct correlations between CSI indicators and age, duration of RA, its activity according to DAS-28, SDAI and CDAI, global assessment of the patient’s condition (VAS-p and VAS-d) and functional capacity according to HAQ. Conclusions. CS is present in 36.9% of RA patients and is associated with age, longer disease duration, worse course of RA and may be a predictor of rapid progression to more severe radiological stages, high disease activity, and worse functional capacity in such patients.