Musculoskeletal pain common in patients with PAH

Musculoskeletal pain is common in patients with pulmonary arterial hypertension and significantly affects quality of life and physical function, researchers reported in Respiratory Medicine.

“In PAH patients, oxygenation of the skeletal muscles is restricted due to the insufficient cardiac output and chronic arterial hypoxemia. In addition, PAH patients have increased levels of pro-inflammatory cytokines in the systemic circulation,” Melih Zeren, MD, of the faculty of health sciences in the division of physiotherapy and rehabilitation at Izmir Bakirçay University in Izmir, Turkey, and Serdar M. Küçükolu, MD, from the department of cardiology at the Istanbul University-Cerrahpaa Cardiology Institute, told Healio. “These factors adversely affect muscle metabolism and may damage muscle tissue. On the other hand, there are also side effects including leg, back or joint pain reported with the use of PAH-specific drugs.”

Researchers evaluated 61 patients with PAH (mean age, 50 years; 90% women) using the Nordic Musculoskeletal Questionnaire for musculoskeletal pain presence, EmPHasis-10 questionnaire and Minnesota Living with Heart Failure Questionnaire for quality of life, 6-minute walk test for functional exercise capacity and International Physical Activity Questionnaire – Short Form for physical activity participation.

Seventy-seven patients reported musculoskeletal pain, with the highest pain prevalence at the low back (38%), knees (36%), shoulders (36%) and neck (33%). In various parts of the body, hemodynamic PAH severity indicators were associated with pain presence, the researchers wrote.

Pain prevalence was more likely to be reported by patients with PAH who received any PAH-specific drug compared with the 33% of patients who did not yet initiate drug therapy (P = .007).

Neck, shoulder, lower back and knee pain were correlated with worse quality of life scores (P < .05). Knee pain had the strongest influence on quality of life and was the only significant correlate of 6-minute walk test and the International Physical Activity Questionnaire (P < .05 for both), according to the researchers.

Zeren and Küçükolu said the initial hypothesis was that chronic musculoskeletal pain in any part of the body would significantly impair quality of life, which was not the case in this study, as knee pain was the strongest predictor of worse quality of life and functionality. This may be due to patients considering their own mobility as the most important aspect of their daily living, Zeren and Küçükolu noted.

“Future studies may directly compare the pain prevalence of PAH patients to a healthy control group for exploring to what extent does PAH increase the risk of having musculoskeletal pain,” Zeren and Küçükolu told Healio. “It would also be beneficial to investigate the efficiency of different management strategies of musculoskeletal pain and whether they improve the general management of this disease.”

For more information:

Serdar M. Küçükolu, MD, can be reached at kucukoglu2@yahoo.com.