类风湿性关节炎的残留疼痛:这是一个真正的问题吗?
Piercarlo Sarzi-Puttini1, Margherita Zen2, Federico Arru2
1IRCCS Galeazzi-S.Ambrogio Hospital, Rheumatology Department, Milan, Italy; Department of Biomedical and Clinical Sciences, Università degli studi di Milano, Milan, Italy.
Autoimmunity reviews
|August 27, 2023
概括
类风湿性关节炎 (RA) 中的残留慢性疼痛,尽管可以控制炎症,但仍然存在,包括中心敏感化和纤维肌痛. 雅克抑制剂在减少这种疼痛方面表现有前途,可能独立于抗炎作用.
科学领域:
- 类风湿病学 类风湿病学
- 疼痛医学 医学 疼痛医学
- 免疫学 免疫学 免疫学
背景情况:
- 类风湿性关节炎 (RA) 经常涉及严重的残留慢性疼痛,影响患者的生活质量.
- 即使在最佳的炎症疾病控制下,这种疼痛也可能持续存在,这表明除了活性炎症之外的机制.
- 中枢敏感性和并发性纤维肌痛综合征 (FMS) 越来越多地被认为是 RA 持续疼痛的贡献者.
研究的目的:
- 探索复杂的机制背后的残留慢性疼痛在类风湿性关节炎.
- 调查非炎症过程,中心敏感化和纤维肌痛在RA疼痛中的作用.
- 评估JAK抑制剂在治疗RA患者残留疼痛方面的疗效.
主要方法:
- 审查有关RA疼痛机制的当前文献,包括神经炎症,细胞因子通路 (TNFα,IL-6) 和JAK-STAT通路.
- 对调查RA患者纤维肌痛综合征的患病率和影响的研究进行分析.
- 检查RA残留疼痛管理中JAK抑制剂的临床试验数据.
主要成果:
- 在RA的残留疼痛涉及复杂的途径超越炎症,包括中央敏感和神经内分泌反应.
- 纤维肌痛综合征在RA患者中很常见,并加剧疼痛,受抑郁症和睡眠障碍等因素的影响.
- 雅克抑制剂已在减少残留的RA疼痛方面表现出有效性,这表明独立于直接抗炎作用的机制.
结论:
- 在RA中残留的疼痛是一个多因素的问题,需要一种综合的方法,而不仅仅是控制炎症.
- 识别和管理并发性纤维肌痛是有效的疼痛管理在RA至关重要的.
- 雅克抑制剂代表了对RA残留疼痛的有希望的治疗选择,具有潜在的非炎症性疼痛调节作用.
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