The role of pain in Graves' orbitopathy: Associations with clinical activity and quality of life
Gijsbert J. Hötte, Willem A. Dik, Ronald O. B. de Keizer, Sodaba Khatab, Marco Medici, Maaike de Bie, P. Martin van Hagen, Dion ParidaensAbstract
Purpose
Pain is included in the clinical activity score (CAS) as an indicator of inflammatory activity in Graves' orbitopathy (GO), yet its clinical relevance has not been systematically evaluated. We therefore investigated the relationship between pain, other inflammatory signs and quality of life (QoL), and assessed the effect of intravenous methylprednisolone (IVMP) treatment on pain perception in GO.
Methods
In this prospective study, 40 patients with GO were assessed pre‐treatment and 12 and 24 weeks after initiation of IVMP treatment. Pain was measured using numeric rating scale (NRS) scores for spontaneous retrobulbar pain, pain on eye movements and pain on touching the eye. QoL was evaluated using the TED‐QOL and GO‐QOL questionnaires.
Results
Pre‐treatment NRS scores correlated with their corresponding CAS pain items, but not with the total 5‐item CAS. Pre‐treatment QoL correlated with spontaneous retrobulbar pain and pain on eye movements. In multivariate analysis, clinically meaningful improvement in pain on eye movements at 12 weeks independently predicted improvement in TED‐QOL and GO‐QOL appearance. At 24 weeks, improvement in pain on touching the eye independently predicted improvement in TED‐QOL function. IVMP significantly reduced NRS pain scores at both follow‐up visits. At 12 weeks, changes in total 5‐item CAS correlated with changes in pain on eye movements and pain on touching the eye.
Conclusions
Pain perception in GO is closely associated with QoL, both pre‐treatment and in response to IVMP. Pain represents a clinically relevant, treatment‐responsive component of GO, supporting the inclusion of pain items within the CAS.