Dataset Information

Central Pain Sensitization in Patients with Chronic Plaque Psoriasis.

ABSTRACT:

Background

Central sensitization (CS) is a condition characterized by a disproportionate response to pain stimuli, and is associated with chronic pain conditions such as fibromyalgia, but also with inflammatory arthropathies such as rheumatoid arthritis and psoriatic arthritis (PsA). CS has never been investigated in patients with psoriasis. The aim of this study is to investigate CS in patients with chronic plaque psoriasis.

Methods

This research involved a cross-sectional observational study of adult patients with moderate-to-severe psoriasis consecutively attending the outpatient clinic of the University Hospital of Verona. Demography, measures of disease severity or activity [i.e., Psoriasis Area and Severity Index (PASI), Disease Activity in Psoriatic Arthritis (DAPSA)], diagnosis of PsA, hypertension, and diabetes were collected. Central Sensitization Inventory (CSI), Dermatology Life Quality Index (DLQI), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) were administered.

Results

A total of 194 patients, including 115 (59%) men, with mean age of 54 ± 13 years, mean PASI of 12.7 ± 6.7, and mean DAPSA of 14.4 ± 3.8 were included. In total, 134 patients (79%) had only psoriasis while 60 (31%) had psoriasis and PsA; 19 (10%) patients had CSI score ≥ 40, which is the threshold for diagnosing CS. The proportion of CS ≥ 40 was higher in patients with PsA compared with psoriasis (17% versus 7%, p = 0.031). The mean CSI score in patients with PsA was higher compared with those with only psoriasis (27.5 ± 13.5 versus 20.7 ± 13.7, p = 0.002). An association between CSI and DLQI [β = 1.25 (95% CI 0.85-1.66)], PASI [β = 1.22 (95% CI 0.74-1.65)], GAD-7 [β = 2.07 (95% CI 1.69-2.45)] and PHQ-9 [β = 2.16 (95% CI 1.76-2.54)] was found independently from age, gender, diabetes, and PsA.

Conclusions

Central sensitization may be associated with psoriasis, particularly in those with high PASI, concomitant PsA, anxiety, depression, and severe quality of life impairment.

SUBMITTER: Bellinato F

PROVIDER: S-EPMC10149419 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Central Pain Sensitization in Patients with Chronic Plaque Psoriasis.

Bellinato Francesco F Gisondi Paolo P Fassio Angelo A Girolomoni Giampiero G

Dermatology and therapy 20230329 5

<h4>Background</h4>Central sensitization (CS) is a condition characterized by a disproportionate response to pain stimuli, and is associated with chronic pain conditions such as fibromyalgia, but also with inflammatory arthropathies such as rheumatoid arthritis and psoriatic arthritis (PsA). CS has never been investigated in patients with psoriasis. The aim of this study is to investigate CS in patients with chronic plaque psoriasis.<h4>Methods</h4>This research involved a cross-sectional observ ...[more]

PMID: 36988902

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Project description:Psoriasis affects 1-3% of the population, in some people causing changes to the nails and joints in addition to skin lesions. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of systemic drug treatments, topical drug treatments, and non-drug treatments (other than ultraviolet light) for chronic plaque psoriasis? What are the effects of ultraviolet light treatments for chronic plaque psoriasis? What are the effects of combined treatment with drugs plus ultraviolet light on chronic plaque psoriasis? What are the effects of combined systemic plus topical drug treatments for chronic plaque psoriasis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2007 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 122 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, adding calcipotriol (topical) to psoralen plus ultraviolet light A or ultraviolet light B, adding oral retinoids to psoralen plus ultraviolet A (PUVA), alefacept, balneotherapy, ciclosporin, dithranol, T cell-targeted therapies, cytokine blocking agents, emollients (alone or plus ultraviolet light B), etanercept, fish oil supplementation, fumaric acid derivatives, Goeckerman treatment, heliotherapy, infliximab, Ingram regimen, keratolytics (salicylic acid, urea), leflunomide, methotrexate, oral pimecrolimus, phototherapy plus balneotherapy, psoralen plus ultraviolet A, psychotherapy, oral retinoids (alone or with ultraviolet light B), systemic drug treatments plus topical vitamin D derivatives, tars, tazarotene, topical corticosteroids (alone or plus oral retinoids), topical Vitamin D derivatives, ultraviolet light A, and ultraviolet light B.

Project description:BackgroundCentral sensitization is considered a key mechanism underlying neuropathic pain (NP) after spinal cord injury (SCI).MethodsTwo novel proxies for central sensitization were investigated in thoracic SCI subjects with (SCI-NP) and without NP (SCI-nonNP) compared to healthy controls (HC). Specifically, temporal summation of pain (TSP) was investigated by examining pain ratings during a 2-min tonic heat application to the volar forearm. Additionally, palmar heat-induced sympathetic skin responses (SSR) were recorded in order to reveal changes in pain-autonomic interaction above the lesion level. Pain extent was assessed as the percentage of the body area and the number of body regions being affected by NP.ResultsEnhanced TSP was observed in SCI-NP (+66%) compared to SCI-nonNP (-75%, p = 0.009) and HC (-59%, p = 0.021). In contrast, no group differences were found (p = 0.685) for SSR habituation. However, pain extent in SCI-NP was positively correlated with deficient SSR habituation (body area: r = 0.561, p = 0.024; body regions: r = 0.564, p = 0.023).ConclusionsThese results support the value of TSP and heat-induced SSRs as proxies for central sensitization in widespread neuropathic pain syndromes after SCI. Measures of pain-autonomic interaction emerged as a promising tool for the objective investigation of sensitized neuronal states in chronic pain conditions.SignificanceWe present two surrogate readouts for central sensitization in neuropathic pain following SCI. On the one hand, temporal summation of tonic heat pain is enhanced in subjects with neuropathic pain. On the other hand, pain-autonomic interaction reveals potential advanced measures in chronic pain, as subjects with a high extent of neuropathic pain showed diminished habituation of pain-induced sympathetic measures. A possible implication for clinical practice is constituted by an improved assessment of neuronal hyperexcitability potentially enabling mechanism-based treatment.

Project description:IntroductionPruritus is a prevalent symptom, described as one of the most bothersome of psoriasis. Specific itch management remains a challenge, for which hydrotherapy could be used as adjunct care to medical treatment. Therefore, we assessed the immediate and longer-term benefit of 3 weeks of Avène thermal spring water hydrotherapy on chronic pruritus in patients in addition to their usual psoriasis and/or pruritus management.MethodsTwenty-six patients suffering from chronic pruritus due to psoriasis were evaluated before and after 3 weeks of hydrotherapy with a 3 and 6 month follow-up. A control group (18 patients) did not undergo hydrotherapy and continued to follow their usual skin management. Pruritus was assessed according to the numeric rating scale (NRS, pruritus intensity), the visual dynamic pruritus score (vDPS, change in pruritus intensity), and the 5-D itch scale (pruritus characteristics). Psoriasis severity was measured using the psoriasis area and severity index (PASI) score. The "itchy quality of life" (ItchQoL) scale was used to assess quality-of-life (QoL) impact related to itch. Pruritus and psoriasis gene and protein biomarkers were measured in lesional and nonlesional skin.ResultsPruritus measurements (NRS, vDPS, and 5-D itch scale) indicated an immediate and long-lasting positive effect of hydrotherapy compared with control patients. The psoriasis area and severity index (PASI) was decreased by 40.0% by hydrotherapy, which was sustained over 6 months. The ItchQoL also improved directly after hydrotherapy, which was still much improved even 6 months later. Analysis of gene and/or protein biomarkers revealed a significant decrease of inflammation biomarkers (IL-8, IL-1α, IL-1RA, and RANTES), of psoriasis biomarkers (PI3, S100A7, and IL-17), and of pruritus biomarkers (IL-31, TRPV1, and CGRP1).ConclusionsThese findings demonstrated an immediate and long-lasting improvement of pruritus in patients with psoriasis who underwent Avène thermal spring water hydrotherapy, indicating that this would be a good complementary therapy in the management of this disease.Trial registrationNCT03023254.

Dataset Information

Central Pain Sensitization in Patients with Chronic Plaque Psoriasis.

Background

Methods

Results

Conclusions

Publications

Central Pain Sensitization in Patients with Chronic Plaque Psoriasis.

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