Diz osteoartritinde radyolojik evrelemenin nöropatik ağrı ve santral sensitizasyon ile ilişkisi
Relationship of radiological staging in neuropathic painand central sensitization in knee osteoarthritis
Yazar: GİZEM GÜMÜRDÜ
Danışman: DR. ÖĞR. ÜYESİ TUBA TÜLAY KOCA
Kahramanmaraş Sütçü İmam Üniversitesi / Tıp Fakültesi / Fiziksel Tıp ve Rehabilitasyon Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2019
Konu: Fiziksel Tıp ve Rehabilitasyon = Physical Medicine and Rehabilitation
Dizin: Ağrı = Pain ; Diz = Knee ; Diz eklemi = Knee joint ; Kronik ağrı = Chronic pain ; Nöropatiler = Neuropathies ; Osteoartrit = Osteoarthritis ; Osteoartrit-diz = Osteoarthritis-knee ; Radyografi = Radiography

Özet:
Giriş ve 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 Yöntem: Çalışma prospektif tanımlayıcı olan planlandı. Çalışmaya Tıp
Fakültesi Hastanesi Fiziksel Tıp ve Rehabilitasyon polikliniğine başvuran 79 hasta dahil
edildi. Hastaların yaş, cinsiyet, vücut kitle indeksi (VKİ) kaydedildi. Osteoartrit
radyolojik evrelemesi için Kellgren Lawrance (KL) evreleme sistemi, ağrı varlığı
Western Ontario ve McMaster Universitesi Artrit İndex (WOMAC), nöropatik ağrı
varlığı Nöropatik Semptom ve Bulguların Özdeğerlendirimi (S-LANSS) ve santral
sensitizasyon Santral Sensitizasyon Envanteri (SSE) ile değerlendirildi.
Bulgular: Katılımcıların (N=79) 44'ünde (%55.7) nöropatik ağrı, 67'sinde (%84.8)
santral sensitizasyon gözlendi. Katılan 79 hastanın 70'i kadın (%88.6), 9'u (%11.4)
erkek cinsiyette idi. Hastaların yaş ortalaması 56.45±7.07 yıl ve VKİ 32.83±5.54 kg/m2
idi. Kellgren Lawrence 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). VKİ'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 S_LANNSS 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 TKS (rho=0.277; P=0.014) ile pozitif korele
idi.
Sonuç: Diz OA olan hastalarda nöropatik ağrı ve santral sensitizasyon radyolojik evre
ve hastalık şiddeti ile korele olarak sıklıkla hastalara eşlik etmektedir. Bu hastalarda
nöropatik ağrı ve santral sensitizasyon varlığı yaşam kalitesini olumsuz etkiler. Bu
nedenle hastalığın takibinde nöropatik ağrı ve santral sensitizasyonun göz önüne
alınması gereklidir.
Anahtar Kelimeler: osteoartrit, santral sensitizasyon, nöropatik ağrı, kronik ağrı

Abstract:
Background and Aim: 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 long-term 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 central
sensitization was observed in 67 (84.8%) of the participants. Of the 79 patients, 70 were
female (88.6%) 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 Kellgren Lawrence
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 
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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). SLANSS 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 TKS (rho = 0.277; P = 0.014).
 WOMAC (P = 0.00) and SSE score (P = 0.00) were significantly higher in
patients with neuropathic pain. According to CL stage; The patients with advanced
stage of KL (stage 3-4) and low (stage 1-2) were in advanced age group (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).
In this group, S-LANNSS; WOMAC (rho = 0.348; P = 0.002) (Figure 2) was positively
correlated with SSE score (rho = 0.483; P = 0.000). The SSE score was positively
correlated with WOMAC (rho = 0.417; P = 0.000), TKS (rho = 0.277; P = 0.014). TSS
and WOMAC (rho = 0.378; P = 0.001) were positively correlated (Table 9). The S
LANSS and WOMAC scores were found to be higher in women compared to the KL
stage when we divided the group into two groups. SSE score (P = 0.00) and BMI (P =
0.02) were significantly higher in women.
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
central sensitization should be considered in the follow-up of the disease.
Keywords: osteoarthritis, central sensitization, neuropathic pain, chronic pain