{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T15:34:25Z","timestamp":1790264065073,"version":"4.1.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Adv Rheumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic pain (CP) in radiographic Axial Spondyloarthritis (r-axSpA) is primarily peripheral nociceptive pain. However, many patients experience persistent pain despite treatment, suggesting other underlying mechanisms, such as central sensitization (CS) and neuropathy. This study assessed the presence of CS and\/or neuropathic pain (NP) in r-axSpA patients treated at a University Hospital in the state of Paraiba.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This quantitative, descriptive, and cross-sectional observational study used a convenience sample collected over 24 weeks. Instruments included the Central Sensitization Inventory - CSI (positive score\u2009\u2265\u200940); The PainDETECT Questionnaire - PD-Q (positive score\u2009\u2265\u200919); clinical epidemiological questionnaires, and preliminary diagnostic for fibromyalgia (FM) [American College of Rheumatology criteria of 2010\/2011, revised in 2016], applied when CS positive. Inclusion criteria: patients diagnosed with r-axSpA; aged\u2009\u2265\u200918. Analyses performed: Descriptive; univariate and multivariate linear regressions; Student\u2019s T-test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This study included 52 patients (34 men and 18 women), of whom 61.54% had CS. Among these, 65.62% had FM, with an average widespread pain index of 7.87. NP was present in 17.31%, and 15.38% had both CS and NP. The CSI showed a positive correlation with Bath Ankylosing Spondylitis Disease Activity Index - BASDAI (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.574) and Axial Spondyloarthritis Disease Activity Score - ASDAS (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.622), while the PD-Q was positively correlated with BASDAI (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.515) and ASDAS (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.551). In the univariate analysis, CSI was a predictor (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) of both BASDAI and ASDAS, with 40.63% of patients scoring BASDAI\u2009\u2265\u20094 and 43.75% scoring ASDAS\u2009\u2265\u20092.1. Additionally, 66.67% of patients with PD-Q\u2009\u2265\u200919 had BASDAI\u2009\u2265\u20094 and 55.56% had ASDAS\u2009\u2265\u20092.1. The PD-Q was a predictor of BASDAI and ASDAS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study is the first in the Brazilian scientific literature to investigate and demonstrate the occurrence of CS and\/or NP in patients with r-axSpA, even when adequately treated. Another finding considered relevant was the demonstration of the presence of CS in 34.38% of patients who did not meet preliminary criteria for the diagnosis of FM, emphasizing the importance of investigating other painful mechanisms in chronic inflammatory joint diseases. These findings represent a first step for future research, in larger samples and in other forms of axial spondyloarthritis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42358-025-00475-2","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T18:30:24Z","timestamp":1758738624000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of the presence of neuropathic pain and\/or central sensitization in patients with radiographic axial spondyloarthritis followed at a tertiary hospital"],"prefix":"10.1186","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8441-2756","authenticated-orcid":false,"given":"D\u00e9bora de Jesus","family":"Sena","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5967-4862","authenticated-orcid":false,"given":"Maria Nathalia Gabriela Rocha Ponte","family":"Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3507-2456","authenticated-orcid":false,"given":"Maria Roberta Melo Pereira","family":"Soares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6737-1760","authenticated-orcid":false,"given":"Lu\u00eds F\u00e1bio Barbosa","family":"Botelho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7515-3947","authenticated-orcid":false,"given":"Alessandra de Sousa","family":"Braz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"475_CR1","doi-asserted-by":"publisher","first-page":"42","DOI":"10.5935\/2595-0118.20200010","volume":"3","author":"GH Dion\u00edsio","year":"2020","unstructured":"Dion\u00edsio GH, Salermo VY, Padilha A. Central sensitization and beliefs among patients with chronic pain in a primary health care unit. Braz J Pain. 2020;3:42\u20137. https:\/\/doi.org\/10.5935\/2595-0118.20200010.","journal-title":"Braz J Pain"},{"key":"475_CR2","doi-asserted-by":"publisher","first-page":"3203","DOI":"10.3390\/jcm10153203","volume":"10","author":"J Nijs","year":"2021","unstructured":"Nijs J, Lahousse A, Kapreli E, Bilika P, Sara\u00e7o\u011flu \u0130, Malfliet A, et al. Nociplastic pain criteria or recognition of central sensitization? Pain phenotyping in the past, present and future. J Clin Med. 2021;10:3203. https:\/\/doi.org\/10.3390\/jcm10153203.","journal-title":"J Clin Med"},{"key":"475_CR3","doi-asserted-by":"publisher","first-page":"1976","DOI":"10.1097\/j.pain.0000000000001939","volume":"161","author":"SN Raja","year":"2020","unstructured":"Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised international association for the study of pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161:1976\u201382. https:\/\/doi.org\/10.1097\/j.pain.0000000000001939.","journal-title":"Pain"},{"key":"475_CR4","doi-asserted-by":"publisher","first-page":"694","DOI":"10.3390\/life13030694","volume":"13","author":"C Fern\u00e1ndez-de-las-Pe\u00f1as","year":"2023","unstructured":"Fern\u00e1ndez-de-las-Pe\u00f1as C, Nijs J, Cagnie B, Gerwin RD, Plaza-Manzano G, Valera-Calero JA, et al. Myofascial pain syndrome: a nociceptive condition comorbid with neuropathic or nociplastic pain. Life (Basel). 2023;13:694. https:\/\/doi.org\/10.3390\/life13030694.","journal-title":"Life (Basel)"},{"key":"475_CR5","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1136\/ard-2023-225185","volume":"83","author":"D van der Heijde","year":"2024","unstructured":"van der Heijde D, Molto A, Ramiro S, Braun J, Dougados M, van Gaalen FA, et al. Goodbye to the term ankylosing spondylitis, hello axial spondyloarthritis: time to embrace the ASAS-defined nomenclature. Ann Rheum Dis. 2024;83:547\u20139. https:\/\/doi.org\/10.1136\/ard-2023-225185.","journal-title":"Ann Rheum Dis"},{"key":"475_CR6","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/S2665-9913(21)00032-1","volume":"3","author":"J Nijs","year":"2021","unstructured":"Nijs J, George SZ, Clauw DJ, Fern\u00e1ndez-de-las-Pe\u00f1as C, Kosek E, Ickmans K, et al. Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. Lancet Rheumatol. 2021;3:383\u201392. https:\/\/doi.org\/10.1016\/S2665-9913(21)00032-1.","journal-title":"Lancet Rheumatol"},{"key":"475_CR7","unstructured":"Braz AS, Ranzolin A, Heymann RE. Dores Musculoesquel\u00e9ticas Localizadas e Difusas. 3o ed. Manole; 2022."},{"key":"475_CR8","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1159\/000493390","volume":"27","author":"J Bullock","year":"2018","unstructured":"Bullock J, Rizvi SAA, Saleh AM, Ahmed SS, Do DP, Ansari RA, et al. Rheumatoid arthritis: A brief overview of the treatment. Med Princ Pract. 2018;27:501\u20137. https:\/\/doi.org\/10.1159\/000493390.","journal-title":"Med Princ Pract"},{"key":"475_CR9","doi-asserted-by":"publisher","first-page":"4476","DOI":"10.1093\/rheumatology\/keab019","volume":"60","author":"SC Kieskamp","year":"2021","unstructured":"Kieskamp SC, Paap D, Carbo MJG, Wink F, Bos R, Bootsma H, et al. Central sensitization, illness perception and obesity should be considered when interpreting disease activity in axial spondyloarthritis. Rheumatology (Oxford). 2021;60:4476\u201385. https:\/\/doi.org\/10.1093\/rheumatology\/keab019.","journal-title":"Rheumatology (Oxford)"},{"key":"475_CR10","doi-asserted-by":"publisher","first-page":"151933","DOI":"10.1016\/j.semarthrit.2021.11.006","volume":"52","author":"SC Kieskamp","year":"2022","unstructured":"Kieskamp SC, Paap D, Carbo MJG, Wink F, Bos R, Bootsma H, et al. Central sensitization has major impact on quality of life in patients with axial spondyloarthritis. Semin Arthritis Rheum. 2022;52:151933. https:\/\/doi.org\/10.1016\/j.semarthrit.2021.11.006.","journal-title":"Semin Arthritis Rheum"},{"key":"475_CR11","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1007\/s40122-021-00310-8","volume":"10","author":"L Zhou","year":"2021","unstructured":"Zhou L, Li T, Wu X, Lu H, Lin L, Ye L, et al. Assessment of neuropathic pain in ankylosing spondylitis: prevalence and characteristics. Pain Ther. 2021;10:1467\u201379. https:\/\/doi.org\/10.1007\/s40122-021-00310-8.","journal-title":"Pain Ther"},{"key":"475_CR12","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1111\/papr.13162","volume":"22","author":"F Salaffi","year":"2022","unstructured":"Salaffi F, Farah S, Mariani C, Sarzi-Puttini P, Di Carlo M. Validity of the central sensitization inventory compared with traditional measures of disease severity in fibromyalgia. Pain Pract. 2022;22:702\u201310. https:\/\/doi.org\/10.1111\/papr.13162.","journal-title":"Pain Pract"},{"key":"475_CR13","doi-asserted-by":"publisher","first-page":"413","DOI":"10.5114\/reum.2022.123671","volume":"60","author":"BF Kocyigit","year":"2022","unstructured":"Kocyigit BF, Akyol A. Fibromyalgia syndrome: epidemiology, diagnosis and treatment. Reumatologia. 2022;60:413\u201321. https:\/\/doi.org\/10.5114\/reum.2022.123671.","journal-title":"Reumatologia"},{"key":"475_CR14","unstructured":"Shinjo SK, Moreira C. Livro da Sociedade Brasileira de Reumatologia. 2o ed. Manole; 2020."},{"key":"475_CR15","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1111\/papr.12875","volume":"20","author":"R Andias","year":"2020","unstructured":"Andias R, Silva AG. Cross-cultural adaptation and psychometric properties of the European Portuguese version of the central sensitization inventory in adolescents with musculoskeletal chronic pain. Pain Pract. 2020;20:480\u201390. https:\/\/doi.org\/10.1111\/papr.12875.","journal-title":"Pain Pract"},{"key":"475_CR16","doi-asserted-by":"publisher","unstructured":"do Rio JPM, Bittencourt JV, Corr\u00eaa LA, Freynhagen R, Reis FJJ dos, de Melo TB et al. Cross-cultural adaptation of the painDETECT questionnaire into Brazilian Portuguese. Braz J Anesthesiol. 2022;72:44\u20138. https:\/\/doi.org\/10.1016\/j.bjane.2021.06.013","DOI":"10.1016\/j.bjane.2021.06.013"},{"key":"475_CR17","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.jaut.2014.01.015","volume":"48\u201349","author":"SP Raychaudhuri","year":"2014","unstructured":"Raychaudhuri SP, Deodhar A. The classification and diagnostic criteria of ankylosing spondylitis. J Autoimmun. 2014;48\u201349:128\u201333. https:\/\/doi.org\/10.1016\/j.jaut.2014.01.015.","journal-title":"J Autoimmun"},{"key":"475_CR18","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","volume":"54","author":"FC Bull","year":"2020","unstructured":"Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World health organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54:1451\u201362. https:\/\/doi.org\/10.1136\/bjsports-2020-102955.","journal-title":"Br J Sports Med"},{"key":"475_CR19","first-page":"2286","volume":"21","author":"S Garrett","year":"1994","unstructured":"Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the bath ankylosing spondylitis disease activity index. J Rheumatol. 1994;21:2286\u201391.","journal-title":"J Rheumatol"},{"key":"475_CR20","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1136\/ard.2008.094870","volume":"68","author":"C Lukas","year":"2009","unstructured":"Lukas C, Landew\u00e9 R, Sieper J, Dougados M, Davis J, Braun J, et al. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis. 2009;68:18\u201324. https:\/\/doi.org\/10.1136\/ard.2008.094870.","journal-title":"Ann Rheum Dis"},{"key":"475_CR21","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1111\/papr.12440","volume":"17","author":"R Neblett","year":"2017","unstructured":"Neblett R, Hartzell MM, Mayer TG, Cohen H, Gatchel RJ. Establishing clinically relevant severity levels for the central sensitization inventory. Pain Pract. 2017;17:166\u201375. https:\/\/doi.org\/10.1111\/papr.12440.","journal-title":"Pain Pract"},{"key":"475_CR22","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1007\/s40122-024-00601-w","volume":"13","author":"Y He","year":"2024","unstructured":"He Y, Wang J, Zhao P, Wang R, Li M. Correlations of the central sensitization inventory, conditioned pain modulation, cognitions and psychological factors in individuals with chronic neck pain: a cross-sectional study. Pain Ther. 2024;13:843\u201356. https:\/\/doi.org\/10.1007\/s40122-024-00601-w.","journal-title":"Pain Ther"},{"key":"475_CR23","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1016\/j.ajem.2018.01.008","volume":"36","author":"O Karcioglu","year":"2018","unstructured":"Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of the pain scales in adults: which to use? Am J Emerg Med. 2018;36:707\u201314. https:\/\/doi.org\/10.1016\/j.ajem.2018.01.008.","journal-title":"Am J Emerg Med"},{"key":"475_CR24","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/j.semarthrit.2016.08.012","volume":"46","author":"F Wolfe","year":"2016","unstructured":"Wolfe F, Clauw DJ, Fitzcharles M-A, Goldenberg DL, H\u00e4user W, Katz RL, et al. 2016 revisions to the 2010\/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016;46:319\u201329. https:\/\/doi.org\/10.1016\/j.semarthrit.2016.08.012.","journal-title":"Semin Arthritis Rheum"},{"key":"475_CR25","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1038\/s41413-019-0057-8","volume":"7","author":"W Zhu","year":"2019","unstructured":"Zhu W, He X, Cheng K, Zhang L, Chen D, Wang X, et al. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res. 2019;7:22. https:\/\/doi.org\/10.1038\/s41413-019-0057-8.","journal-title":"Bone Res"},{"key":"475_CR26","doi-asserted-by":"publisher","unstructured":"Brand\u00e3o PLKO, Filho ST, de Santos A, dos JGC, Bastos Junior MP, Lessa GP dos, Pascoal SS et al. DB, Estudo Comparativo das Doen\u00e7as Inflamat\u00f3rias Articulares Espondilite Anquilosante e Artrite Reumat\u00f3ide. Braz Appl Sci Rev. 2020;4:2258\u201368. https:\/\/doi.org\/10.34115\/basrv4n4-011","DOI":"10.34115\/basrv4n4-011"},{"key":"475_CR27","unstructured":"Brasil M, da S. ESPONDILITE ANCILOSANTE - Protocolo cl\u00ednico e diretrizes terap\u00eauticas - PCDT. Gov.br. 2018. https:\/\/www.gov.br\/saude\/pt-br\/assuntos\/protocolos-clinicos-e-diretrizes-terapeuticas-pcdt\/arquivos\/2018\/espondilite-ancilosante-pcdt.pdf\/view (accessed on August 18, 2024)."},{"key":"475_CR28","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s42358-020-00161-5","volume":"61","author":"G Citera","year":"2021","unstructured":"Citera G, Bautista-Molano W, Pel\u00e1ez-Ballestas I, Azevedo VF, Perich RA, M\u00e9ndez-Rodr\u00edguez JA, et al. Prevalence, demographics, and clinical characteristics of Latin American patients with spondyloarthritis. Adv Rheumatol. 2021;61:2. https:\/\/doi.org\/10.1186\/s42358-020-00161-5.","journal-title":"Adv Rheumatol"},{"key":"475_CR29","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1136\/ard-2022-223296","volume":"82","author":"S Ramiro","year":"2023","unstructured":"Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2023;82:19\u201334. https:\/\/doi.org\/10.1136\/ard-2022-223296.","journal-title":"Ann Rheum Dis"},{"key":"475_CR30","doi-asserted-by":"publisher","first-page":"14365","DOI":"10.34119\/bjhrv5n4-198","volume":"5","author":"ANE Costa","year":"2022","unstructured":"Costa ANE, Napoli AER. Revis\u00e3o bibliogr\u00e1fica da abordagem do tratamento da dor cr\u00f4nica n\u00e3o oncol\u00f3gica, com base na escada analg\u00e9sica da organiza\u00e7\u00e3o mundial de sa\u00fade. Braz J Hea Rev. 2022;5:14365\u201381. https:\/\/doi.org\/10.34119\/bjhrv5n4-198.","journal-title":"Braz J Hea Rev"},{"key":"475_CR31","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1007\/s00296-023-05317-2","volume":"43","author":"A Sariyildiz","year":"2023","unstructured":"Sariyildiz A, Coskun Benlidayi I, Turk I, Zengin Acemoglu SS, Unal I. Biopsychosocial factors should be considered when evaluating central sensitization in axial spondyloarthritis. Rheumatol Int. 2023;43:923\u201332. https:\/\/doi.org\/10.1007\/s00296-023-05317-2.","journal-title":"Rheumatol Int"},{"key":"475_CR32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.17826\/cumj.503652","volume":"44","author":"T Koca","year":"2019","unstructured":"Koca T, G\u00f6\u011febakan H, \u00c7eti\u0307n G. Should central sensitization and neuropathic pain be considered in disease activity and treatment decision in axial ankylosing spondilitis? Cukurova Med J. 2019;44:1\u201310. https:\/\/doi.org\/10.17826\/cumj.503652.","journal-title":"Cukurova Med J"},{"key":"475_CR33","doi-asserted-by":"publisher","first-page":"104","DOI":"10.5114\/reum\/163223","volume":"61","author":"I Kedyk","year":"2023","unstructured":"Kedyk I, Stanislavchuk M. Clinical characteristics of ankylosing spondylitis patients depending on neuropathic pain. Reumatologia. 2023;61:104\u20138. https:\/\/doi.org\/10.5114\/reum\/163223.","journal-title":"Reumatologia"},{"key":"475_CR34","doi-asserted-by":"publisher","first-page":"257","DOI":"10.3906\/sag-1707-147","volume":"48","author":"D Geler-K\u00fclc\u00fc","year":"2018","unstructured":"Geler-K\u00fclc\u00fc D, Bat\u0131bay S, \u00d6zt\u00fcrk G, Mesci N. The association of neuropathic pain and disease activity, functional level, and quality of life in patients with ankylosing spondylitis: a cross-sectional study. Turk J Med Sci. 2018;48:257\u201365. https:\/\/doi.org\/10.3906\/sag-1707-147.","journal-title":"Turk J Med Sci"},{"key":"475_CR35","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1097\/RHU.0000000000000711","volume":"24","author":"K Gok","year":"2018","unstructured":"Gok K, Cengiz G, Erol K, Ozgocmen S. Neuropathic pain component in axial spondyloarthritis and the influence on disease burden. J Clin Rheumatol. 2018;24:324\u20137. https:\/\/doi.org\/10.1097\/RHU.0000000000000711.","journal-title":"J Clin Rheumatol"},{"key":"475_CR36","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s10067-019-04749-1","volume":"39","author":"MA Guler","year":"2020","unstructured":"Guler MA, Celik OF, Ayhan FF. The important role of central sensitization in chronic musculoskeletal pain seen in different rheumatic diseases. Clin Rheumatol. 2020;39:269\u201374. https:\/\/doi.org\/10.1007\/s10067-019-04749-1.","journal-title":"Clin Rheumatol"}],"container-title":["Advances in Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42358-025-00475-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42358-025-00475-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42358-025-00475-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T11:43:18Z","timestamp":1781610198000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s42358-025-00475-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,24]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["475"],"URL":"https:\/\/doi.org\/10.1186\/s42358-025-00475-2","relation":{},"ISSN":["2523-3106"],"issn-type":[{"value":"2523-3106","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,24]]},"assertion":[{"value":"14 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Regarding ethical aspects, this study was approved by the Medical Ethics Committee of the Center for Medical Sciences at UFPB (CAAE No. 70626623.6.0000.5183), in compliance with ethical guidelines outlined in CNS Resolution No. 466\/2012 of the Brazilian Ministry of Health.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"All participants agreed to take part in the study by providing authorization through the Informed Consent Form before data collection. The identities of research volunteers were appropriately protected.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"39"}}