Patients with non-radiographic axial spondyloarthritis (nr-axSpA) and radiographic axSpA/ankylosing spondylitis (AS) have similar disease burdens; however, the potential significance of pain features, especially the neuropathic pain (NeP) component, has yet to be determined. For a study, researchers had to first determine the frequency of NeP components in patients with axSpA, and then determine the possible effect of NeP on disease burden. Adult patients with axSpA who satisfied the Assessment of SpondyloArthritis International Society categorization criteria were recruited sequentially. The Douleur Neuropathique en 4 Questions interview and the painDETECT questionnaire were used to assess patients, who were then classified as having or not having NeP. 

Neuropathic pain was found in 31.4% of patients with axSpA who were classified using the Douleur Neuropathique en 4 Questions (31.6% in nr-axSpA vs 31.3% in AS, P=0.964) and 33.5% of patients who were classified using painDETECT (35.1% in nr-axSpA vs 32.8% in AS, P=0.762). Patients with nr-axSpA and AS had pain characteristics that were quite comparable. Women tended to have greater NeP on a regular basis. When compared to patients without NeP component, patients with NeP component had significantly higher scores on the visual analog scale of pain, patient and physician global, fatigue, Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity Score using C-reactive protein, depression, anxiety scores, and physical functions; poorer quality of life (QoL); and a similar frequency of fibromyalgia. Having NeP was linked to QoL measures (Ankylosing Spondylitis Quality of Life and Short-Form 36 physical component score) and the visual analog scale of weariness in multivariable analysis.

Regardless of whether they have nr-axSpA or AS about one-third of individuals with axSpA may have a NeP component. Neuropathic pain can lead to a reduced quality of life and lower patient-reported outcomes, so it’s important to keep that in mind while evaluating patients.