THU0418 NEUROPATHIC-LIKE PAIN IN PERSONS WITH HAND OSTEOARTHRITIS AND ASSOCIATIONS WITH PERIPHERAL AND CENTRAL SENSITIZATION
Authors: Pernille Steen Pettersen, Tuhina Neogi, Marthe Gløersen, Karin Magnusson, Hilde Berner Hammer, Tore K. Kvien, Till Uhlig, Ida Kristin Haugen
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Despite no current knowledge of lesions or disease of the sensory nervous system in osteoarthritis (OA), subgroups of knee OA patients report neuropathic-like pain. The neuropathic-like pain component has been suggested to reflect central sensitization. <h3>Objectives:</h3> To describe the prevalence of neuropathic-like pain in persons with hand OA and explore whether neuropathic-like pain associate with peripheral and/or central sensitization. <h3>Methods:</h3> These cross-sectional analyses included 280 participants with hand OA from the Nor-Hand study. A modified PainDETECT questionnaire was used to characterize neuropathic-like hand pain (mPD-hand, 0-36 scale). We conducted quantitative sensory testing (QST) of pressure pain thresholds (PPT) and temporal summation (TS). Low PPTs at local sites (painful finger joint and non-painful finger joint) indicate peripheral and/or central sensitization, while low PPTs at extra-segmental sites (radioulnar joint, musculus trapezius and tibialis anterior) indicate central sensitization. TS, defined as an increase in pain ≥2 on a numeric rating scale (NRS, 0-10) during a repetition of ten punctate stimuli at the wrist, indicate central sensitization. Participants with painful hand OA (NRS of hand pain above the patient acceptable symptom score of ≥4), were categorized as having either nociceptive pain (mPD-hand ≤12) or neuropathic-like pain (mPD-hand score &gt;12). We examined whether reporting nociceptive or neuropathic-like pain, as compared to no/mild pain (NRS hand pain below 4) was associated with QST results using regression analyses. <h3>Results:</h3> In this study sample, 88% were female, median age was 61 (IQR 57-66) years and 94% fulfilled the ACR criteria for hand OA. Median mPD-hand score was 8 (IQR 3, 13). Half of the participants (n=144, 51%) reported NRS pain ≥4, of whom 58 (40%) had neuropathic-like pain. Those with neuropathic-like pain reported higher mean (SD) NRS pain severity than persons with nociceptive pain (5.9 (1.6) vs 5.3 (1.5), p=0.01). We found that neuropathic-like pain was associated to higher pain sensitization reflected by lower PPT at the painful finger joint (Table), non-painful finger joint (beta -1.6, 95% CI -2.3, -0.9), radioulnar joint (beta -1.1, 95% CI -1.8, -0.4), trapezius (Table) and tibialis anterior (-1.0, 95% CI -1.8, -0.2) and presence of TS (Table). The associations between nociceptive pain and sensitization were weaker than the associations observed for neuropathic-like pain (Table). <sup>1</sup>Linear regression, <sup>2</sup>logistic regression. Adjusted for age, sex, BMI, use of analgesics, level of education, sleep disturbance, Pain Catastrophizing Scale, the Hospital Anxiety and Depression Scale and radiographic hand OA severity (Kellgren-Lawrence sum score). <h3>Conclusion:</h3> Of persons with painful hand OA, 40% have a neuropathic-like pain component. Reporting neuropathic-like pain is associated with peripheral and central sensitization, indicated by low PPTs and presence of TS. Our results suggest that patients who report neuropathic-like symptoms are more likely to have sensitization-associated pain.&nbsp; <h3>&nbsp;Disclosure of Interests:</h3> Pernille Steen Pettersen: None declared, Tuhina Neogi: None declared, Marthe Gløersen: None declared, Karin Magnusson: None declared, Hilde Berner Hammer Grant/research support from: AbbVie, Pfizer and Roche, Paid instructor for: AbbVie, Pfizer, UCB, Novartis, Roche, Speakers bureau: AbbVie, Pfizer, UCB, Novartis, Roche, Tore K. Kvien Grant/research support from: AbbVie, BMS, MSD, Pfizer, Roche and UCB., Consultant for: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi, Mylan and UCB, Speakers bureau: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi and UCB, Till Uhlig Consultant for: Grünenthal, Novartis, Speakers bureau: Grünenthal, Novartis, Ida Kristin Haugen Grant/research support from: ADVANCE research grant from Pfizer, Consultant for: Advisory board Abbvie