Pacheco da Silva I.1, Sudré Cezarino R.1, Neves Rodrigues K.1, Luis Aires da Rocha W.1, Clara Bonini-Rocha A.1, Luiz Carregaro R.1, Castro Blasczyk J.2, Massao Kawano M.3, Alves de Paiva I.4, Rodrigues Martins W.1
1Universidade de Brasilia, Brasilia, Brazil, 2Secretaria do Estado de Saúde do Distrito Federal, Brasilia, Brazil, 3Universidade Federal do Oeste da Bahia, Center of Biological and Health Sciences, Barreiras, Brazil, 4Hospital das Forças Armadas, Brasilia, Brazil
Background: Chronic low back pain (CLBP) is considered a public health problem associated with high economic costs in industrialized nations. The direct costs of patients with low back pain in the United States of America are approximately $100 billion per year. In Europe, the costs are between 2 and 4 billion euros per year.
Purpose: Compare clinical, physical and functional characteristics in two groups of individuals with chronic low back pain: a group of patients with systemic lupus erythematosus (SLE) and another one with degenerative joint disease (DJD) in the lumbar spine.
Methods: This is a cross-sectional study (non-probabilistic sample) conduced in the ambulatory of SLE and DJD of the Brasilia University Hospital (DF, Brazil). We evaluated 25 SLE patients (mean age of 43 years [SD = 13.9]) and 30 patients with DJD (mean age of 49 years [SD = 9]). The outcomes analyzed were: Numeric Pain Rating Scales (NPRS), Oswestry Disability Index (ODI), Tampa Scale of Kinesiophobia (TSK), Fatigue Severity Scale (FSS), Schober Test (ST) and maximal voluntary isometric contraction (MVIC) of handgrip (HG) and back muscles (BM). Mann-Whitney U test, Unpaired t test and Chi-square test were used in the statistical analysis, and the significance was set at 5 % for all analysis. All analyzes were performed using SPSS software, version 21.0.
Results: The median time course of pain was 2 years (IQ = 9) in SLE patients and 3 years (IQ = 6.5) in DJD patients. The age (years), gender (men´s and womans), body mass index, scholarity (illiterate, elementary school, high school or higher education) current comorbidities, occupation (yes or no), self-evaluation of health (good, regular or bad) and physical activity (over 150 minutes) between groups were not statistical different. Patients with DJD showed a higher prevalence of diffuse (83%) and irradiation (80%) back pain when compared to SLE patients, which demonstrated a local (76%) and without irradiation (76%) back pain (p 0.0001). Patients with DJD also showed more level of severity in the Quebec Task Force Classification System (40% of level 4 in DJD and 83% of level 1 in SLE; p=0.0002). Finally, DJD patients showed significantly higher scores on NPRS (p=0.003), ODI (p 0.0001), TSK (p=0.009) and less values on ST (p=0.03). The others dependent variables showed no statistical differences (FSS and MVIC of the HG and BM).
Conclusion(s): Patients with DJD and CLBP presents worst clinical caractheristics when compared with SLE patients. The intensity of CLBP (NPRS), related functional disability (ODI), lumbar range of motion (ST) and kinesiphobia (TSK) outcomes were most affected in DJD patients.
Implications: SLE is a chronic inflammatory disease, autoimmune, which negatively affects multiple organs and systems. Inflammatory arthritis is considered the most frequent cause of musculoskeletal pain. Despite this, SLE patients demonstrated less severity when compared with patients with the DJD. Considering that CLBP in DJD patients could be the primary focus of individual health problem, in contrastic with the multiples health problems in SLE, its possible that a local DJD leads to worst biological adaptations.
Funding acknowledgements: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ).
Topic: Musculoskeletal: spine
Ethics approval: This project was approved in 2014 by the Research Ethics Committee of University of Brasilia (27527214.7.0000.0030).
All authors, affiliations and abstracts have been published as submitted.
