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Research ArticleAccepted Article

Chronic pain and assessment of pain sensitivity in patients with axial spondyloarthritis: Results from the SPARTAKUS cohort

Elisabeth Mogard, Tor Olofsson, Stefan Bergman, Ann Bremander, Lars-Erik Kristensen, Jack Kvistgaard Olsen, Johan K. Wallman and Elisabet Lindqvist
The Journal of Rheumatology December 2020, jrheum.200872; DOI: https://doi.org/10.3899/jrheum.200872
Elisabeth Mogard
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Skåne University Hospital, Department of Rheumatology, Lund, Sweden; Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark; The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark. Supported by grants from the Faculty of Medicine, at Lund University; Region Skåne; Skåne University Hospital; Spenshult Research and Development Centre; ALF Region Skåne; the Swedish Rheumatism Association; the Anna-Greta Crafoord Foundation; the Kock Foundation; the Österlund Foundation; and the Lundgren Foundation. Conflict of interest: TO has received interview fees from Eli Lilly and provided consultancy for Merck, Sharp & Dohme (MSD) (unrelated to the present work). LEK has received consultancy and speaker’s bureau fees from AbbVie; Amgen; Biogen; Bristol-Myers Squibb (BMS); Celgene; Eli Lilly; Janssen Pharmaceuticals; Merck, Sharp & Dohme (MSD); Novartis; Pfizer; Roche; Sannofi; and UCB Pharma (unrelated to the present work). JKW has received consultancy fees from AbbVie; Celgene; Eli Lilly; Novartis; and UCB Pharma (unrelated to the present work). The remaining authors have no competing interests. Corresponding author: Elisabeth Mogard, Department of Rheumatology, Skåne University Hospital, Kioskgatan 5, SE-221 85 Lund, Sweden. E-mail: elisabeth.mogard@med.lu.se.
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Tor Olofsson
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Skåne University Hospital, Department of Rheumatology, Lund, Sweden; Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark; The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark. Supported by grants from the Faculty of Medicine, at Lund University; Region Skåne; Skåne University Hospital; Spenshult Research and Development Centre; ALF Region Skåne; the Swedish Rheumatism Association; the Anna-Greta Crafoord Foundation; the Kock Foundation; the Österlund Foundation; and the Lundgren Foundation. Conflict of interest: TO has received interview fees from Eli Lilly and provided consultancy for Merck, Sharp & Dohme (MSD) (unrelated to the present work). LEK has received consultancy and speaker’s bureau fees from AbbVie; Amgen; Biogen; Bristol-Myers Squibb (BMS); Celgene; Eli Lilly; Janssen Pharmaceuticals; Merck, Sharp & Dohme (MSD); Novartis; Pfizer; Roche; Sannofi; and UCB Pharma (unrelated to the present work). JKW has received consultancy fees from AbbVie; Celgene; Eli Lilly; Novartis; and UCB Pharma (unrelated to the present work). The remaining authors have no competing interests. Corresponding author: Elisabeth Mogard, Department of Rheumatology, Skåne University Hospital, Kioskgatan 5, SE-221 85 Lund, Sweden. E-mail: elisabeth.mogard@med.lu.se.
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Stefan Bergman
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Skåne University Hospital, Department of Rheumatology, Lund, Sweden; Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark; The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark. Supported by grants from the Faculty of Medicine, at Lund University; Region Skåne; Skåne University Hospital; Spenshult Research and Development Centre; ALF Region Skåne; the Swedish Rheumatism Association; the Anna-Greta Crafoord Foundation; the Kock Foundation; the Österlund Foundation; and the Lundgren Foundation. Conflict of interest: TO has received interview fees from Eli Lilly and provided consultancy for Merck, Sharp & Dohme (MSD) (unrelated to the present work). LEK has received consultancy and speaker’s bureau fees from AbbVie; Amgen; Biogen; Bristol-Myers Squibb (BMS); Celgene; Eli Lilly; Janssen Pharmaceuticals; Merck, Sharp & Dohme (MSD); Novartis; Pfizer; Roche; Sannofi; and UCB Pharma (unrelated to the present work). JKW has received consultancy fees from AbbVie; Celgene; Eli Lilly; Novartis; and UCB Pharma (unrelated to the present work). The remaining authors have no competing interests. Corresponding author: Elisabeth Mogard, Department of Rheumatology, Skåne University Hospital, Kioskgatan 5, SE-221 85 Lund, Sweden. E-mail: elisabeth.mogard@med.lu.se.
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Ann Bremander
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Skåne University Hospital, Department of Rheumatology, Lund, Sweden; Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark; The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark. Supported by grants from the Faculty of Medicine, at Lund University; Region Skåne; Skåne University Hospital; Spenshult Research and Development Centre; ALF Region Skåne; the Swedish Rheumatism Association; the Anna-Greta Crafoord Foundation; the Kock Foundation; the Österlund Foundation; and the Lundgren Foundation. Conflict of interest: TO has received interview fees from Eli Lilly and provided consultancy for Merck, Sharp & Dohme (MSD) (unrelated to the present work). LEK has received consultancy and speaker’s bureau fees from AbbVie; Amgen; Biogen; Bristol-Myers Squibb (BMS); Celgene; Eli Lilly; Janssen Pharmaceuticals; Merck, Sharp & Dohme (MSD); Novartis; Pfizer; Roche; Sannofi; and UCB Pharma (unrelated to the present work). JKW has received consultancy fees from AbbVie; Celgene; Eli Lilly; Novartis; and UCB Pharma (unrelated to the present work). The remaining authors have no competing interests. Corresponding author: Elisabeth Mogard, Department of Rheumatology, Skåne University Hospital, Kioskgatan 5, SE-221 85 Lund, Sweden. E-mail: elisabeth.mogard@med.lu.se.
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Lars-Erik Kristensen
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Skåne University Hospital, Department of Rheumatology, Lund, Sweden; Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark; The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark. Supported by grants from the Faculty of Medicine, at Lund University; Region Skåne; Skåne University Hospital; Spenshult Research and Development Centre; ALF Region Skåne; the Swedish Rheumatism Association; the Anna-Greta Crafoord Foundation; the Kock Foundation; the Österlund Foundation; and the Lundgren Foundation. Conflict of interest: TO has received interview fees from Eli Lilly and provided consultancy for Merck, Sharp & Dohme (MSD) (unrelated to the present work). LEK has received consultancy and speaker’s bureau fees from AbbVie; Amgen; Biogen; Bristol-Myers Squibb (BMS); Celgene; Eli Lilly; Janssen Pharmaceuticals; Merck, Sharp & Dohme (MSD); Novartis; Pfizer; Roche; Sannofi; and UCB Pharma (unrelated to the present work). JKW has received consultancy fees from AbbVie; Celgene; Eli Lilly; Novartis; and UCB Pharma (unrelated to the present work). The remaining authors have no competing interests. Corresponding author: Elisabeth Mogard, Department of Rheumatology, Skåne University Hospital, Kioskgatan 5, SE-221 85 Lund, Sweden. E-mail: elisabeth.mogard@med.lu.se.
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Jack Kvistgaard Olsen
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Skåne University Hospital, Department of Rheumatology, Lund, Sweden; Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark; The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark. Supported by grants from the Faculty of Medicine, at Lund University; Region Skåne; Skåne University Hospital; Spenshult Research and Development Centre; ALF Region Skåne; the Swedish Rheumatism Association; the Anna-Greta Crafoord Foundation; the Kock Foundation; the Österlund Foundation; and the Lundgren Foundation. Conflict of interest: TO has received interview fees from Eli Lilly and provided consultancy for Merck, Sharp & Dohme (MSD) (unrelated to the present work). LEK has received consultancy and speaker’s bureau fees from AbbVie; Amgen; Biogen; Bristol-Myers Squibb (BMS); Celgene; Eli Lilly; Janssen Pharmaceuticals; Merck, Sharp & Dohme (MSD); Novartis; Pfizer; Roche; Sannofi; and UCB Pharma (unrelated to the present work). JKW has received consultancy fees from AbbVie; Celgene; Eli Lilly; Novartis; and UCB Pharma (unrelated to the present work). The remaining authors have no competing interests. Corresponding author: Elisabeth Mogard, Department of Rheumatology, Skåne University Hospital, Kioskgatan 5, SE-221 85 Lund, Sweden. E-mail: elisabeth.mogard@med.lu.se.
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Johan K. Wallman
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Skåne University Hospital, Department of Rheumatology, Lund, Sweden; Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark; The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark. Supported by grants from the Faculty of Medicine, at Lund University; Region Skåne; Skåne University Hospital; Spenshult Research and Development Centre; ALF Region Skåne; the Swedish Rheumatism Association; the Anna-Greta Crafoord Foundation; the Kock Foundation; the Österlund Foundation; and the Lundgren Foundation. Conflict of interest: TO has received interview fees from Eli Lilly and provided consultancy for Merck, Sharp & Dohme (MSD) (unrelated to the present work). LEK has received consultancy and speaker’s bureau fees from AbbVie; Amgen; Biogen; Bristol-Myers Squibb (BMS); Celgene; Eli Lilly; Janssen Pharmaceuticals; Merck, Sharp & Dohme (MSD); Novartis; Pfizer; Roche; Sannofi; and UCB Pharma (unrelated to the present work). JKW has received consultancy fees from AbbVie; Celgene; Eli Lilly; Novartis; and UCB Pharma (unrelated to the present work). The remaining authors have no competing interests. Corresponding author: Elisabeth Mogard, Department of Rheumatology, Skåne University Hospital, Kioskgatan 5, SE-221 85 Lund, Sweden. E-mail: elisabeth.mogard@med.lu.se.
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Elisabet Lindqvist
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Skåne University Hospital, Department of Rheumatology, Lund, Sweden; Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark; The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark. Supported by grants from the Faculty of Medicine, at Lund University; Region Skåne; Skåne University Hospital; Spenshult Research and Development Centre; ALF Region Skåne; the Swedish Rheumatism Association; the Anna-Greta Crafoord Foundation; the Kock Foundation; the Österlund Foundation; and the Lundgren Foundation. Conflict of interest: TO has received interview fees from Eli Lilly and provided consultancy for Merck, Sharp & Dohme (MSD) (unrelated to the present work). LEK has received consultancy and speaker’s bureau fees from AbbVie; Amgen; Biogen; Bristol-Myers Squibb (BMS); Celgene; Eli Lilly; Janssen Pharmaceuticals; Merck, Sharp & Dohme (MSD); Novartis; Pfizer; Roche; Sannofi; and UCB Pharma (unrelated to the present work). JKW has received consultancy fees from AbbVie; Celgene; Eli Lilly; Novartis; and UCB Pharma (unrelated to the present work). The remaining authors have no competing interests. Corresponding author: Elisabeth Mogard, Department of Rheumatology, Skåne University Hospital, Kioskgatan 5, SE-221 85 Lund, Sweden. E-mail: elisabeth.mogard@med.lu.se.
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Abstract

Objective To study differences in pain reports between patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA), and to assess how pain sensitivity measures associate with disease and health outcomes.

Methods Consecutive patients with axial SpA (axSpA) were enrolled in the populationbased SPARTAKUS cohort (2015‒2017), and classified as AS (n=120) or nr-axSpA (n=55). Pain was assessed with questionnaires (intensity/duration/distribution) and computerized cuff pressure algometry to measure pain sensitivity (pain threshold/pain tolerance/temporal summation of pain). Linear regression models were used to compare pain measures between AS and nr-axSpA patients, and to assess associations between pain sensitivity measures and disease and health outcomes.

Results Of 175 axSpA patients, 44% reported chronic widespread pain, with no significant differences in any questionnaire-derived or algometry-assessed pain measures between AS and nr-axSpA patients. Lower pain tolerance was associated with longer symptom duration, worse ASDAS-CRP, BASFI, and BASMI, more pain regions, unacceptable pain, worse MASES, fatigue, anxiety, and health-related quality of life. Furthermore, lower pain threshold was associated with worse ASDAS-CRP and MASES, while higher temporal summation was associated with longer symptom duration, unacceptable pain and worse BASMI.

Conclusion Chronic pain is common in axSpA, with no observed differences in any pain measures between patients with AS and nr-axSpA. Furthermore, higher pain sensitivity is associated with having worse disease and health outcomes. The results indicate that patients with AS and nr-axSpA, in line with most clinical characteristics, have a similar pain burden and they highlight large unmet needs regarding individualized pain management, regardless of axSpA subgroup.

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The Journal of Rheumatology
Vol. 49, Issue 7
1 Jul 2022
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Accepted manuscript
Chronic pain and assessment of pain sensitivity in patients with axial spondyloarthritis: Results from the SPARTAKUS cohort
Elisabeth Mogard, Tor Olofsson, Stefan Bergman, Ann Bremander, Lars-Erik Kristensen, Jack Kvistgaard Olsen, Johan K. Wallman, Elisabet Lindqvist
The Journal of Rheumatology Dec 2020, jrheum.200872; DOI: 10.3899/jrheum.200872

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Accepted manuscript
Chronic pain and assessment of pain sensitivity in patients with axial spondyloarthritis: Results from the SPARTAKUS cohort
Elisabeth Mogard, Tor Olofsson, Stefan Bergman, Ann Bremander, Lars-Erik Kristensen, Jack Kvistgaard Olsen, Johan K. Wallman, Elisabet Lindqvist
The Journal of Rheumatology Dec 2020, jrheum.200872; DOI: 10.3899/jrheum.200872
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