Central Sensitization Is Common in Axial Spondyloarthritis, Which Could Explain Why Up to 40% of Patients on Biologics Still Have High Levels of Chronic Pain

There’s little doubt that axial spondyloarthritis (axSpA) can be very painful to live with. This chronic form of arthritis impacts the lower spine and the sacroiliac joints that connect it to the pelvis. Inflammation in those areas can be extremely uncomfortable, as can the bone deformities that sometimes develop. But there’s another factor that rheumatologists might not be fully taking into account when assessing the current severity of a patient’s condition: central sensitization.

Central sensitization means that pain receptors in the central nervous system are hypersensitive. If two people come in contact with the same stimulus — let’s say they bump their back against a door frame —the one who has central sensitization will feel more pain, even if both people got bumped in exactly the same way. People with central sensitization might also mistakenly perceive stimuli that are normally not painful at all (like someone gently patting your shoulder) as extremely uncomfortable.

According to a study presented at the European E-Congress of Rheumatology 2020, held virtually by the European League Against Rheumatism (EULAR), central sensitization might explain why 40 percent of axSpA patients report experiencing chronic pain despite having been on a TNF inhibitor for seven years. It’s possible, the authors implied, that doctors aren’t sufficiently treating a patient’s pain because objective measures of disease activity show that the intended targets are being reached.

The researchers, who are from the Netherlands, had people with axSpA complete three different questionnaires designed to assess pain levels and compared them to objective measures of disease activity. They found that even though patients’ mean disease activity scores indicated they were not in high disease activity, the presence of central sensitization was very common and that it should be given more attention when a provider is when determining how to best treat patient with this condition.

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If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.