The role of disease activity as a determinant of body awareness and central sensitization in patients with axial spondyloarthritis: a cross-sectional study
Abstract
Aims: The aim of this study was to investigate the effects of disease activity on body awareness and central sensitization in patients with axial spondyloarthritis (axSpA).
Methods: This cross-sectional study included patients diagnosed with axSpA. Disease activity was evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and a score of four or higher was considered high disease activity. Patients were divided into two groups according to BASDAI: high disease activity (BASDAI ≥ 4) group (HG) and the low disease activity (BASDAI<4) group (LG). Body awareness levels were assessed with the Body Awareness Questionnaire (BAQ). The Central Sensitization Inventory (CSI) was used for central sensitivity. Simple linear regression analyses were performed to investigate which of the independent variables could explain the disease activity.
Results: Sixty-two patients with a mean disease duration of 10.8 years were included. The mean BASDAI, CSI-A, and BAQ were 4.2, 38.5, and 73 points, respectively. Demographics and clinical characteristics were comparable between the groups (p>0.05). The CSI-A score was higher in HG compared to LG (44 (31-54) vs. 31 (21-41), p=0.008). The HG had poorer BAQ scores than the LG (61 (52-85) vs. 85 (64-96), p=0.017). BASDAI was moderately associated with CSI-A (r=0.145, R2=0.172, p=0.001). No significant correlation was found between BASDAI and BAQ (p=0.167). The results of the simple linear regression analysis suggested that CSI-A explained 17.2% of the disease activity. BASDAI (β = 0.415, p=0.001) significantly predicted central sensitization. BASDAI was strongly correlated with VAS (r=0.665, R2= 0.442, p<0.001). The VAS explained 44.2% of the disease activity, and BASDAI (r=0.665, p<0.001) significantly predicted pain severity.
Conclusion: High disease activity adversely affects central sensitization and body awareness in patients with axSpA. Physicians should also consider a multimodal biopsychosocial perspective in the management of patients with high disease activity.
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References
- Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73-84. doi:10.1016/s0140-6736(16)31591-4
- Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A. Ankylosing spondylitis: an overview. Ann Rheum Dis. 2002;61 Suppl 3(Suppl 3):iii8-18. doi:10.1136/ard.61.suppl_3.iii8
- Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the bath ankylosing spondylitis disease activity index. J Rheumatol. 1994;21(12):2286-91.
- Bas DB, Su J, Wigerblad G, Svensson CI. Pain in rheumatoid arthritis: models and mechanisms. Pain Manag. 2016;6(3):265-84. doi:10.2217/pmt.16.4
- Loeser JD, Treede RD. The Kyoto protocol of IASP basic pain terminology. Pain. 2008;137(3):473-477. doi:10.1016/j.pain.2008.04.025
- Kieskamp SC, Paap D, Carbo MJG, et al. Central sensitization, illness perception and obesity should be considered when interpreting disease activity in axial spondyloarthritis. Rheumatology (Oxford). 2021;60(10):4476-4485. doi:10.1093/rheumatology/keab019
- Arends S, Brouwer E, Efde M, et al. Long-term drug survival and clinical effectiveness of etanercept treatment in patients with ankylosing spondylitis in daily clinical practice. Clin Exp Rheumatol. 2017;35(1):61-68.
- Baskan E, Yagci N, Cavlak U. Factors affecting body awareness in older adults with chronic musculoskeletal pain. Arch Med Sci. 2021;17(4):934-939. doi:10.5114/aoms.2019.86614
- Kalkışım ŞN, Erden A, Kanber Uzun Ö, Ertemoğlu Öksüz C, Zihni NB, Çan MA. Relationship between body awareness level and musculoskeletal pain complaints, physical activity level and emotional status in healthy people. Acta Neurol Belg. 2022. doi:10.1007/s13760-022-02056-2
- Baas LS, Beery TA, Allen G, Wizer M, Wagoner LE. An exploratory study of body awareness in persons with heart failure treated medically or with transplantation. J Cardiovasc Nurs. 2004;19(1):32-40. doi:10.1097/00005082-200401000-00007
- Bekker MH, Croon MA, Van Balkom EG, Vermee JB. Predicting individual differences in autonomy-connectedness: the role of body awareness, alexithymia, and assertiveness. J Clin Psychol. 2008;64(6):747-65. doi:10.1002/jclp.20486
- Durlik C, Cardini F, Tsakiris M. Being watched: the effect of social self-focus on interoceptive and exteroceptive somatosensory perception. Conscious Cogn. 2014;25:42-50. doi:10.1016/j.concog.2014.01.010
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- Erden A, Altuğ F, Cavlak U. Investigation of the relationship between body awareness, pain, emotional status, and quality of life among healthy people. J Kartal Train Res Hosp. 2013;24(3):145-150.
- Bantick SJ, Wise RG, Ploghaus A, Clare S, Smith SM, Tracey I. Imaging how attention modulates pain in humans using functional MRI. Brain. 2002;125(Pt 2):310-9. doi:10.1093/brain/awf022
- Johnson MH. How does distraction work in the management of pain? Curr Pain Headache Rep. 2005;9(2):90-5. doi:10.1007/s11916-005-0044-1
- Burns JW. The role of attentional strategies in moderating links between acute pain induction and subsequent psychological stress: evidence for symptom-specific reactivity among patients with chronic pain versus healthy nonpatients. Emotion. 2006;6(2):180-92. doi:10.1037/1528-3542.6.2.180
- Gard G. Body awareness therapy for patients with fibromyalgia and chronic pain. Disabil Rehabil. 2005;27(12):725-8. doi:10.1080/09638280400009071
- Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777-83. doi:10.1136/ard.2009.108233
- Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52. doi:10.1002/acr.20543
- Mayer TG, Neblett R, Cohen H, et al. The development and psychometric validation of the central sensitization inventory. Pain Pract. 2012;12(4):276-85. doi:10.1111/j.1533-2500.2011.00493.x
- Düzce Keleş E, Birtane M, Ekuklu G, et al. Validity and reliability of the Turkish version of the central sensitization inventory. Arch Rheumatol. 2021;36(4):518-526. doi:10.46497/ArchRheumatol.2022.8665
- Karaca S, Bayar B. Turkish version of body awareness questionnaire: validity and reliability study. Turk J Physiother Rehabil. 2021;32(1):44-50.
- Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69-71.
- Hider S, Wong M, Ortiz M, Dulku A, Mulherin D. Does a regular exercise program for ankylosing spondylitis influence body image? Scand J Rheumatol. 2002;31(3):168-71.
- Buke M, Cetisli-Korkmaz N, Basakci-Calik B, Karasu U. The Association of Physical Activity Level with Body Awareness and Balance in Individuals with Ankylosing Spondylitis. Aktuelle Rheumatol. 2023. doi:10.1055/a-2085-2204.
- Ward MM. Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res. 1999;12(4):247-55.
- Karaca N, Kinikli G, Sezer S, Keleşoğlu B, Kinikli G. POS1589-HPR High disease activity has a negative effect on pain catastrophizing, fear avoidance and body awareness levels in patients with ankylosing spondylitis—a preliminary study. Ann Rheum Dis. 2023;82:1170.
- Guler MA, Celik OF, Ayhan FF. The important role of central sensitization in chronic musculoskeletal pain seen in different rheumatic diseases. Clin Rheumatol. 2020;39(1):269-274. doi:10.1007/s10067-019-04749-1
- Aykurt Karlıbel I, Kasapoğlu Aksoy M. The relationship between central sensitization and disease activity, quality of life, and sleep quality among patients with axial spondyloarthritis. Ir J Med Sci. 2023;192(1):481-489. doi:10.1007/s11845-022-02957-4
- Sariyildiz A, Coskun Benlidayi I, Turk I, Zengin Acemoglu SS, Unal I. Biopsychosocial factors should be considered when evaluating central sensitization in axial spondyloarthritis. Rheumatol Int. 2023;43(5):923-932. doi:10.1007/s00296-023-05317-2
- Kieskamp SC, Paap D, Carbo MJG, et al. Central sensitization has major impact on quality of life in patients with axial spondyloarthritis. Semin Arthritis Rheum. 2022;52:151933. doi:10.1016/j.semarthrit.2021.11.006
Abstract
Project Number
-
References
- Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73-84. doi:10.1016/s0140-6736(16)31591-4
- Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A. Ankylosing spondylitis: an overview. Ann Rheum Dis. 2002;61 Suppl 3(Suppl 3):iii8-18. doi:10.1136/ard.61.suppl_3.iii8
- Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the bath ankylosing spondylitis disease activity index. J Rheumatol. 1994;21(12):2286-91.
- Bas DB, Su J, Wigerblad G, Svensson CI. Pain in rheumatoid arthritis: models and mechanisms. Pain Manag. 2016;6(3):265-84. doi:10.2217/pmt.16.4
- Loeser JD, Treede RD. The Kyoto protocol of IASP basic pain terminology. Pain. 2008;137(3):473-477. doi:10.1016/j.pain.2008.04.025
- Kieskamp SC, Paap D, Carbo MJG, et al. Central sensitization, illness perception and obesity should be considered when interpreting disease activity in axial spondyloarthritis. Rheumatology (Oxford). 2021;60(10):4476-4485. doi:10.1093/rheumatology/keab019
- Arends S, Brouwer E, Efde M, et al. Long-term drug survival and clinical effectiveness of etanercept treatment in patients with ankylosing spondylitis in daily clinical practice. Clin Exp Rheumatol. 2017;35(1):61-68.
- Baskan E, Yagci N, Cavlak U. Factors affecting body awareness in older adults with chronic musculoskeletal pain. Arch Med Sci. 2021;17(4):934-939. doi:10.5114/aoms.2019.86614
- Kalkışım ŞN, Erden A, Kanber Uzun Ö, Ertemoğlu Öksüz C, Zihni NB, Çan MA. Relationship between body awareness level and musculoskeletal pain complaints, physical activity level and emotional status in healthy people. Acta Neurol Belg. 2022. doi:10.1007/s13760-022-02056-2
- Baas LS, Beery TA, Allen G, Wizer M, Wagoner LE. An exploratory study of body awareness in persons with heart failure treated medically or with transplantation. J Cardiovasc Nurs. 2004;19(1):32-40. doi:10.1097/00005082-200401000-00007
- Bekker MH, Croon MA, Van Balkom EG, Vermee JB. Predicting individual differences in autonomy-connectedness: the role of body awareness, alexithymia, and assertiveness. J Clin Psychol. 2008;64(6):747-65. doi:10.1002/jclp.20486
- Durlik C, Cardini F, Tsakiris M. Being watched: the effect of social self-focus on interoceptive and exteroceptive somatosensory perception. Conscious Cogn. 2014;25:42-50. doi:10.1016/j.concog.2014.01.010
- Gyllensten AL, Hui-Chan CW, Tsang WW. Stability limits, single-leg jump, and body awareness in older Tai Chi practitioners. Arch Phys Med Rehabil. 2010;91(2):215-20. doi:10.1016/j.apmr.2009.10.009
- Erden A, Altuğ F, Cavlak U. Investigation of the relationship between body awareness, pain, emotional status, and quality of life among healthy people. J Kartal Train Res Hosp. 2013;24(3):145-150.
- Bantick SJ, Wise RG, Ploghaus A, Clare S, Smith SM, Tracey I. Imaging how attention modulates pain in humans using functional MRI. Brain. 2002;125(Pt 2):310-9. doi:10.1093/brain/awf022
- Johnson MH. How does distraction work in the management of pain? Curr Pain Headache Rep. 2005;9(2):90-5. doi:10.1007/s11916-005-0044-1
- Burns JW. The role of attentional strategies in moderating links between acute pain induction and subsequent psychological stress: evidence for symptom-specific reactivity among patients with chronic pain versus healthy nonpatients. Emotion. 2006;6(2):180-92. doi:10.1037/1528-3542.6.2.180
- Gard G. Body awareness therapy for patients with fibromyalgia and chronic pain. Disabil Rehabil. 2005;27(12):725-8. doi:10.1080/09638280400009071
- Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777-83. doi:10.1136/ard.2009.108233
- Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52. doi:10.1002/acr.20543
- Mayer TG, Neblett R, Cohen H, et al. The development and psychometric validation of the central sensitization inventory. Pain Pract. 2012;12(4):276-85. doi:10.1111/j.1533-2500.2011.00493.x
- Düzce Keleş E, Birtane M, Ekuklu G, et al. Validity and reliability of the Turkish version of the central sensitization inventory. Arch Rheumatol. 2021;36(4):518-526. doi:10.46497/ArchRheumatol.2022.8665
- Karaca S, Bayar B. Turkish version of body awareness questionnaire: validity and reliability study. Turk J Physiother Rehabil. 2021;32(1):44-50.
- Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69-71.
- Hider S, Wong M, Ortiz M, Dulku A, Mulherin D. Does a regular exercise program for ankylosing spondylitis influence body image? Scand J Rheumatol. 2002;31(3):168-71.
- Buke M, Cetisli-Korkmaz N, Basakci-Calik B, Karasu U. The Association of Physical Activity Level with Body Awareness and Balance in Individuals with Ankylosing Spondylitis. Aktuelle Rheumatol. 2023. doi:10.1055/a-2085-2204.
- Ward MM. Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res. 1999;12(4):247-55.
- Karaca N, Kinikli G, Sezer S, Keleşoğlu B, Kinikli G. POS1589-HPR High disease activity has a negative effect on pain catastrophizing, fear avoidance and body awareness levels in patients with ankylosing spondylitis—a preliminary study. Ann Rheum Dis. 2023;82:1170.
- Guler MA, Celik OF, Ayhan FF. The important role of central sensitization in chronic musculoskeletal pain seen in different rheumatic diseases. Clin Rheumatol. 2020;39(1):269-274. doi:10.1007/s10067-019-04749-1
- Aykurt Karlıbel I, Kasapoğlu Aksoy M. The relationship between central sensitization and disease activity, quality of life, and sleep quality among patients with axial spondyloarthritis. Ir J Med Sci. 2023;192(1):481-489. doi:10.1007/s11845-022-02957-4
- Sariyildiz A, Coskun Benlidayi I, Turk I, Zengin Acemoglu SS, Unal I. Biopsychosocial factors should be considered when evaluating central sensitization in axial spondyloarthritis. Rheumatol Int. 2023;43(5):923-932. doi:10.1007/s00296-023-05317-2
- Kieskamp SC, Paap D, Carbo MJG, et al. Central sensitization has major impact on quality of life in patients with axial spondyloarthritis. Semin Arthritis Rheum. 2022;52:151933. doi:10.1016/j.semarthrit.2021.11.006
Details
| Primary Language | English |
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| Subjects | Rheumatology and Arthritis |
| Journal Section | Original Article |
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| Project Number | - |
| Early Pub Date | September 26, 2023 |
| Publication Date | September 28, 2023 |
| Published in Issue | Year 2023 Volume: 6 Issue: 5 |
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