{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:05:49Z","timestamp":1782281149850,"version":"3.54.5"},"reference-count":23,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100010331","name":"Stichting voor Ooglijders","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010331","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010321","name":"Oogfonds","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010321","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002908","name":"Stichting Combined Ophthalmic Research Rotterdam","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002908","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010378","name":"Stichting Wetenschappelijk Onderzoek Oogziekenhuis","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010378","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010372","name":"Rotterdamse Stichting Blindenbelangen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010372","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective study, 40 patients with GO were assessed pre\u2010treatment and 12 and 24\u2009weeks 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\u2010QOL and GO\u2010QOL questionnaires.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Pre\u2010treatment NRS scores correlated with their corresponding CAS pain items, but not with the total 5\u2010item CAS. Pre\u2010treatment QoL correlated with spontaneous retrobulbar pain and pain on eye movements. In multivariate analysis, clinically meaningful improvement in pain on eye movements at 12\u2009weeks independently predicted improvement in TED\u2010QOL and GO\u2010QOL appearance. At 24\u2009weeks, improvement in pain on touching the eye independently predicted improvement in TED\u2010QOL function. IVMP significantly reduced NRS pain scores at both follow\u2010up visits. At 12\u2009weeks, changes in total 5\u2010item CAS correlated with changes in pain on eye movements and pain on touching the eye.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pain perception in GO is closely associated with QoL, both pre\u2010treatment and in response to IVMP. Pain represents a clinically relevant, treatment\u2010responsive component of GO, supporting the inclusion of pain items within the CAS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aos.70179","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:30:06Z","timestamp":1782279006000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The role of pain in Graves' orbitopathy: Associations with clinical activity and quality of life"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3916-0012","authenticated-orcid":false,"given":"Gijsbert J.","family":"H\u00f6tte","sequence":"first","affiliation":[{"name":"Department of Oculoplastic, Lacrimal and Orbital Surgery Rotterdam Eye Hospital  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem A.","family":"Dik","sequence":"additional","affiliation":[{"name":"Department of Immunology, Laboratory Medical Immunology Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"},{"name":"Laboratory Medical Immunology Reinier Haga Medisch Diagnostisch Centrum (RHMDC)  Delft the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald O. B.","family":"de Keizer","sequence":"additional","affiliation":[{"name":"Department of Oculoplastic, Lacrimal and Orbital Surgery Rotterdam Eye Hospital  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sodaba","family":"Khatab","sequence":"additional","affiliation":[{"name":"Department of Oculoplastic, Lacrimal and Orbital Surgery Rotterdam Eye Hospital  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Medici","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Academic Center for Thyroid Diseases Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maaike","family":"de Bie","sequence":"additional","affiliation":[{"name":"Department of Oculoplastic, Lacrimal and Orbital Surgery Rotterdam Eye Hospital  Rotterdam the Netherlands"},{"name":"Department of Immunology, Laboratory Medical Immunology Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. Martin","family":"van Hagen","sequence":"additional","affiliation":[{"name":"Department of Immunology, Laboratory Medical Immunology Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"},{"name":"Department of Internal Medicine, Section Clinical Immunology Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6762-3614","authenticated-orcid":false,"given":"Dion","family":"Paridaens","sequence":"additional","affiliation":[{"name":"Department of Oculoplastic, Lacrimal and Orbital Surgery Rotterdam Eye Hospital  Rotterdam the Netherlands"},{"name":"Department of Ophthalmology Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"},{"name":"Department of Ophthalmology L\u2019H\u00f4pital Fondation Rothschild  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"issue":"4","key":"e_1_2_8_2_1","first-page":"461","article-title":"Validation of Indonesian graves' ophthalmopathy quality of life questionnaire and its association with clinical activity and severity of graves' ophthalmopathy","volume":"56","author":"Anggraini C.","year":"2024","journal-title":"Acta Medica Indonesiana"},{"issue":"8","key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1056\/NEJMra0905750","article-title":"Graves' ophthalmopathy","volume":"362","author":"Bahn R.S.","year":"2010","journal-title":"The New England Journal of Medicine"},{"issue":"4","key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"G43","DOI":"10.1530\/EJE-21-0479","article-title":"The 2021 European group on graves' orbitopathy (EUGOGO) clinical practice guidelines for the medical management of graves' 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