AB0548 SELF-REPORTED NEUROPATHIC PAIN IN A COHORT OF PRIMARY SJOGREN’S SYNDROME
Authors: Inês Rego de Figueiredo, Julie Norris, Wan Fai Ng
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Although pain has been generally accepted being a cardinal symptoms of primary Sjogren's Syndrome (pSS), its cause remains unclear. It can be articular, muscular, neuropathic or related to fibromylagia. Neuropathic pain in pSS has often been associated with peripheral neuropathy, either small-fibre neuropathy or sensory neuropathies, one of the most common neurological complications of pSS. <h3>Objectives:</h3> The aim of this work is to assess the prevalence and associated factors of self-reported neuropathic pain in a cohort of pSS. <h3>Methods:</h3> Questionnaires for screening for neuropathic pain was giving out during routine clinic appointment. The first part of the questionnaire was adapted from the Neuropathic Pain Questionnaire – Short Form(1). The second part was adapted from the Neuropathic Pain Diagnostic Questionnaire (DN4)(2), but only including the self-reported items (7 items related to symptoms), which is scored with a cut-off value of ≥3/7. <h3>Results:</h3> Data from 44 patients attending the Sjogren's clinic were analysed, yielding a female preponderance (86%), with a mean age of 59,6 years old. pSS disease duration on average 9,7 years, antibody positivity of 43% and 34% for anti-Ro and anti-La, respectively. 35 had salivary gland biopsy for diagnosis, the majority (48,6%) having a Focus Score (FS) of 1; 28,6% and 17,1% with FS of 2 and 3, respectively. Also worth mentioning 2 patients had lymphoma in the salivary gland biopsy (DLBC and MALT lymphoma). As for disease scores, ESSDAI mean was 2,5±4,1 and ESSPRI 5,8±2,5. A total of 10 patients (23%) had peripheral neuropathy. For part I: 19 patients (43%) may have neuropathic pain. Overall, patients with neuropathic pain were similar to those without, even considering previous diagnosis of peripheral neuropathy. The exception was the ESSPRI score, in which patients with neuropathic pain had a higher score (6,9±2,4 vs 4,9±2,9, p-value 0.02). As for the individual components of the questionnaire: numbness mean was 37,2, tingling means was 33,7 and increased pain due to touch mean was the lowest with 25,5. None of them was significantly associated with ESSPRI. For part II: 59% of patients may have neuropathic pain. Anti-Ro positivity was lower among patients with neuropathic pain (42% vs 58%, p-value 0.04), biopsy score distribution was different with a predominance of FS 1 in the group with neuropathic pain (88% vs 12%, p-value=0.03) and ESSPRI was again higher in patients with neuropathic pain (6,9±1,4 vs 4,5±2,9; p-value=0.008). Of the individual items: tingling and numbness, pins/needles and itching, burning, painful cold and electric shocks were reported in 57%, 48%, 45%, 34% and 27% respectively. Finally, 36% (16) of the total of patients were positive for neuropathic pain for both parts of the questionnaire. <h3>Conclusion:</h3> The prevalence of neuropathic pain appears to be common among pSS patients, in particular in seronegative patients and associated with lower focus score on salivary gland biopsy. Interestingly, there was no association between neuropathic pain and the previous diagnosis of peripheral neuropathy. This may result of peripheral neuropathy no longer active, and therefore asymptomatic, but may also account for undiagnosed peripheral neuropathy in the group of neuropathic pain or other more general causes of neuropathic pain. <h3>References</h3> [1] Backonja M-M, Krause SJ. Neuropathic Pain Questionnaire—Short Form. Clin J Pain. 2003;19:315–6. [2] Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114(1–2):29–36. <h3>Disclosure of Interests:</h3> None declared