ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
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ORIJINAL ARAŞTIRMA

Diz Osteoartritinde Nöropatik Ağrı ve Santral Sensitizasyonun Hastalık Şiddeti ve Radyolojik Evreleme ile İlişkisi
The Relationship of Neuropathic Pain and Central Sensitization with Disease Severity and Radiological Staging in Knee Osteoarthritis
Received Date : 25 Jun 2019
Accepted Date : 13 Sep 2019
Available Online : 11 Oct 2019
Doi: 10.31609/jpmrs.2019-70363 - Makale Dili: TR
J PMR Sci. 2019;22(3):92-101
ÖZET
Amaç: Osteoartrit (OA), en sık görülen eklem hastalığıdır ve kişinin günlük yaşam aktivitelerini ve sosyal performansını önemli ölçüde bozan bir morbidite nedenidir. Kronik romatizmal pek çok hastalıkta uzun dönemde ağrının kronisite göstermesi hastalık kontrol altına alındığı dönemlerde bile ağrının devam etmesi bize altta yatan başka mekanizmaları düşündürmektedir. Nöropatik ağrı, santral sensitizasyon (SS) ve sendromları kronik romatizmal hastalıklara sıklıkla eşlik etmektedir. Bu çalışmadaki amacımız, diz OA olan hastalarda nöropatik ağrı ve SS varlığını araştırmak ve bunun hastalık şiddeti ve radyolojik evre ile ilişkisini göstermektir. Gereç ve Yöntemler: Çalışma prospektif tanımlayıcı olarak planlandı. Çalışmaya Tıp Fakültesi Hastanesi Fiziksel Tıp ve Rehabilitasyon Polikliniğine başvuran 79 hasta dâhil edildi. Hastaların yaş, cinsiyet, beden kitle indeksi (BKİ) kaydedildi. Osteoartrit radyolojik evrelemesi için Kellgren Lawrance (KL) evreleme sistemi, ağrı varlığı Western Ontario ve McMaster Universitesi Artrit İndeks (WOMAC), nöropatik ağrı varlığı Nöropatik Semptom ve Bulguların Özdeğerlendirimi [Self-Assessment of Neuropathic Symptoms and Signs (S-LANSS)] ve santral sensitizasyon varlığı Santral Sensitizasyon Envanteri (SSE) ile değerlendirildi. Bulgular: Katılımcıların (n=79) 44 (%55,7)’ünde nöropatik ağrı, 67 (%84,8)’sinde SS gözlendi. Katılan 79 hastanın 70 (%88,6)’i kadın, 9 (%11,4)’u erkek cinsiyette idi. Hastaların yaş ortalaması 56,45±7,07 yıl ve BKİ 32,83±5,54 kg/m2 idi. KL evrelemesine göre evre-1 hasta sayısı 1 (%1,3), evre-2 hasta sayısı 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 olarak sınıfladığımızda, ileri evre olan grup daha ileri yaşta idi (p=0,00). BKİ’leri benzerdi (p=0,56). S-LANSS skorları her iki grupta da benzer idi (p=0,17). WOMAC skorları KL 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 SLANNSS skoru; WOMAC (rho=0,348; P=0,002) ve SSE skoru (rho=0,483; p=0,000) ile pozitif korele idi. SSE skor WOMAC (rho=0,417; P=0,000) ve Tampa Kinezyofobi Skalası (rho=0,277; p=0,014) ile pozitif korele idi. Sonuç: Diz OA olan hastalarda nöropatik ağrı ve SS radyolojik evre ve hastalık şiddeti ile sıklıkla koreledir. Bu hastalarda nöropatik ağrı ve SS varlığı yaşam kalitesini olumsuz etkiler. Bu nedenle hastalığın takibinde nöropatik ağrı ve SS’nin göz önüne alınması gereklidir.
ABSTRACT
Objective: Osteoarthritis (OA) is the most common joint disease and is a cause of morbidity which significantly impairs the person’s daily activities and social performance. In chronic rheumatic diseases, the longterm pain chronicity and the continuation of the pain even in the period when the disease is controlled is suggestive of other underlying mechanisms. Neuropathic pain, central sensitization (CS) and syndromes are frequently associated with chronic rheumatic diseases. The aim of this study was to investigate the presence of neuropathic pain and CS in patients with knee OA and to demonstrate its relationship with disease severity and radiological stage. Materials and Methods: The study was planned as a prospective descriptive. The study included 79 patients who were admitted to the Faculty of Medicine, Hospital of Physical Medicine and Rehabilitation outpatient clinic. Age, gender, body mass index (BMI) of the patients were recorded. Kellgren Lawrance (KL) staging system was used for osteoarthritis staging, presence of pain was evaluated by Western Ontario and McMaster University Arthritis Index (WOMAC), presence of neuropathic pain with Self-Assessment of Neuropathic Symptoms and Signs (S-LANSS) and central sensitization with Central Sensitization Inventory (CSE). Results: Neuropathic pain was observed in 44 (55.7%) of the participants and CS was observed in 67 (84.8%) of the participants. Of the 79 patients, 70 (88.6%) were female 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 KL staging, 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 KL stage; when we classified KL as advanced (stage 3-4) and low (stage 1-2) stage, the advanced stage group was at an older age (p=0.00). BMI was 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). WOMAC (p=0.00) and CSE score (p=0.00) were significantly higher in patients with neuropathic pain. In the 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 positively correlated with WOMAC (rho=0.417; p=0.000) and Tampa Scale of Kinesiophobia (rho=0.277; p=0.014). Conclusion: Neuropathic pain and CS are frequently associated with radiological stage and disease severity in patients with knee OA. The presence of neuropathic pain and CS in these patients adversely affects quality of life. For this reason, neuropathic pain and CS should be considered in the follow-up of the disease.
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