Correlation Between Chronic Pain Acceptance and Clinical Variables in Ankylosing Spondylitis and Its Prediction Role for Biologics Treatment

Combined analysis of lncRNAs and mRNAs associated with coloration and wax formation during 'Fumei' Apple development

'Fumei' apple is characterized by high anthocyanin content and thick wax layer. Long non-coding RNAs (lncRNAs) play essential roles in the growth and development of various plants via regulation of gene expression. This study explored the potential mechanism underlying anthocyanin accumulation and cuticular wax formation during the development of 'Fumei' apple fruit. The results demonstrated that anthocyanin accumulation correlates with fruit coloration, while wax content drives wax layer formation. A total of 6039 and 3410 differentially expressed genes (DEGs), as well as 230 and 131 differentially expressed lncRNAs (DELs) were identified in the M1/M2 and M2/M3 pairs, respectively, by using RNA-seq. In the M1/M2 pair, the DEGs were mainly enriched in the 'photosynthesis' and 'flavonoid biosynthesis' pathways; in the M2/M3 pair, the DEGs were significantly enriched in the 'photosynthesis' and 'cutin, suberine and wax biosynthesis' pathways. Furthermore, the structural and regulatory genes involved in anthocyanin and cuticular wax biosynthesis were investigated, and the potential lncRNAs and genes that may control the anthocyanin and cuticular wax biosynthesis were identified. This study provides candidate lncRNAs and potential regulatory genes associated with both the regulation of anthocyanins and wax during apple development.

The mediating role of kinesiophobia in pain intensity, physical function, and physical activity level in inflammatory arthritis

Pain is the main symptom of inflammatory arthritis and it can impair physical functional performance and physical activity level. Some individuals can develop kinesiophobia and experience a vicious circle of worsening health. This study aimed to investigate the association between pain and physical functional performance/physical activity and determine whether kinesiophobia mediates this association. This was a cross-sectional study with individuals diagnosed with inflammatory arthritis (rheumatoid arthritis or spondyloarthritis) treated at a Rheumatology Outpatient Clinic. We assessed pain (Visual Analogue Scale), physical activity (International Physical Activity Questionnaire - long form), kinesiophobia (Tampa Scale for Kinesiophobia), and physical functional performance (Handgrip Strength Dynamometry, 30-second Sit-to-Stand test, Static Muscular Endurance test, and Timed Up and Go test). The mediating effect of kinesiophobia on the relationship between pain intensity and physical functional performance/physical activity was analyzed, and the significance of the mediating effect (kinesiophobia) was tested through a bootstrap approach. Thirty-three individuals with inflammatory arthritis (mean age: 48 ± 12 years) participated in the study. Kinesiophobia mediates the relationship between pain intensity and physical functional performance analyzed by the 30-second Sit-to-Stand test [indirect effect (IE)overall = -0.343, bootstrap 95% confidence interval (CI): -0.698 to -0.002] and by knee flexion at 90º of the dominant limb (IEoverall = -1.55, bootstrap 95% CI: -3.43 to -0.237). In conclusion, pain intensity can affect physical functional performance through kinesiophobia in individuals with inflammatory arthritis.

The Relationship Between Pain Acceptance and Acceptance of Illness in Individuals with Rheumatoid Arthritis

Objective

Managing treatment and symptoms of chronic diseases without accepting the illness is challenging. This study aimed to determine the relationship between pain acceptance and the acceptance of illness in individuals with rheumatoid arthritis (RA).

Methods

In this descriptive study of 123 people diagnosed with rheumatoid arthritis (RA), data were collected through a questionnaire. The questionnaire included a Patient Information Form, Visual Analog Scale (VAS), Health Assessment Questionnaire (HAQ), Disease Activity Score 28 (DAS28), Chronic Pain Acceptance Questionnaire (CPAQ), and Acceptance of Illness Scale (AIS).

Results

The mean chronic pain acceptance score of individuals with RA was 55.32 ± 12.96, and the mean acceptance of illness score was 25.00 ± 8.02. A statistically significant relationship existed between levels of pain measured by VAS and CPAQ (r=-0.184, P=.042). A statistically significant correlation existed between AIS and CPAQ total score (r=0.284, P=.001).

Conclusion

As the levels of pain acceptance increased in RA patients, the levels of pain decreased, and the levels of acceptance of the illness increased. Patients must first acknowledge and accept their illness to follow their treatment plan effectively. Considering that the pain acceptance of individuals diagnosed with RA affects the level of acceptance of illness, it is essential to evaluate patients' pain and disease acceptance processes and support patients to increase treatment success.

Nöropatik ağrı aksiyal spondiloartritte gözden kaçan bir semptom mu?

Amaç: Aksiyal spondiloartitler (axSpA) kronik inflamatuar romatolojik hastalıklardan olup ağrı yaşam kalitelerini etkileyen en sık semptomdur. Literatürde ağrının her zaman inflamasyonla korele olmadığı gösterilmiştir. Bu çalışma ile aksiyal spondiloartrit hastalarında nöropatik ağrının frekansının gösterilmesi ve nöropatik ağrı ile hasta özelliklerinin arasındaki ilişkinin gösterilmesi amaçlanmıştır. Gereç ve Yöntem: Kliniğimizde Ocak- Mart 2019 ayları arasında takip edilen, Assessment of SpondyloArthritis International Society klasifikasyon kriterlerine göre axSpA kabul edilen hastalar çalışmaya dahil edilmiştir. Nöropatik ağrı Douleur Neuropathique en 4 Questions (DN4) ölçeği ile değerlendirildi. Bulgular: Seksen yedi axSpa hastası çalışmaya dahil edildi. Hastaların 30’unda DN4 ölçeğine göre (DN4 >4) nöropatik ağrı var kabul edildi. Nöropatik ağrı aktif hasta grubunda (ASDAS- CRP ve BASDAI’ ye göre) daha fazla saptandı. DN4 skoru ASDAS- CRP ve BASDAI skoru ile orta düzeyde korele saptandı. Hasta eğitim düzeyi ile DN4 skoru arasında hafif düzeyde korelasyon saptandı. Sonuç: Çalışmamızda axSpA hastalarında inflamatuvar ağrıya ek olarak nöropatik ağrının görülebileceği ve hastalık aktivitesi ile korele olabileceği gösterildi. Nöropatik ağrı hastaların yaşam kalitesini bozduğu, sosyal ve emosyonel bozukluklara yol açtığı literatürde gösterilmiştir. Hastalar standart anti inflamatuvar tedavi yaklaşımlarından fayda görmeyebilir. AxSpA hastalarında nöropatik ağrının değerlendirilmesi önem kazanmaktadır. AxSpA hastalarında nöropatik ağrının tanı ve tedavi sürecinde ileri çalışmalara gereksinim duyulmaktadır.

Assessment of Neuropathic Pain in Ankylosing Spondylitis: Prevalence and Characteristics

INTRODUCTION

Pain in ankylosing spondylitis is currently considered an inflammatory pain (IP). However, it was found that some patients still had the sensation of pain even without inflammation. Our study was to investigate the prevalence and characteristics of neuropathic pain (NeP) in Chinese Han ankylosing spondylitis (AS) patients.

METHODS

The study consisted of three parts. Firstly, we assessed the prevalence and clinical data of NeP in 182 AS patients. Secondly, we evaluated pain improvement after etanercept therapy in 63 patients. Finally, serum neurotransmitters were measured for 20 AS patients and ten healthy controls (HC).

RESULTS

Out of 182 AS patients, our study showed that 14 patients (7.70%) had likely NeP and 55 (30.21%) had uncertain NeP. There were significant differences among the three groups with respect to nocturnal pain (NP), peripheral pain (PP), total back pain (TBP), BASDAI, ASDAS-CRP, HAD-A, HAD-D, and BASDAI-fatigue except fort CRP concentrations. Principal component analysis (PCA) of AS pain revealed that the weight of NeP was greater than PP in the first principal component (0.703 vs. 0.639). Structural equation modeling (SEM) revealed that NeP altered disease activity (β = 0.62, P < 0.001), which influenced psychological status (β = 0.42, P < 0.001). Of 63 patients who used etanercept for 3 months, significant improvement was found in NP, TBP, and PP (all P < 0.0001) but not in PDQ (10.60 ± 6.85 vs. 9.98 ± 6.40, P = 0.0671). Serum norepinephrine concentrations in patients with PDQ > 19 were higher than those in patients with PDQ ≤ 19 and HC.

CONCLUSIONS

We conclude that NeP contributes to pain in AS patients.