"炎症性关节炎的炎症性或非炎症性疼痛 - 如何区分它?"
Piercarlo Sarzi-Puttini1, Greta Pellegrino2, Valeria Giorgi3
1Rheumatology Unit, IRCCS Ospedale Galeazzi- Sant' Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
Best practice & research. Clinical rheumatology
|July 14, 2024
概括
类风湿性关节炎 (RA) 中的残留慢性疼痛,尽管控制了疾病,但仍然存在,除了炎症之外还涉及复杂的机制. 简氏激酶 (JAK) 抑制剂在减少这种疼痛方面表现有前途,可能通过非炎症途径.
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:
- 慢性疼痛显著影响类风湿性关节炎 (RA) 和牛皮性关节炎 (PSA) 患者的生活质量.
- 即使控制了炎症,RA的残留疼痛仍然存在,这代表着一个主要的未满足的医疗需求.
- 在RA中疼痛机制包括炎症,神经内分泌反应,细胞因子释放和中央敏感化.
研究的目的:
- 探索RA残留慢性疼痛的多面性质.
- 研究非炎症和中央敏感化机制在持续性RA疼痛中的作用.
- 检查RA患者共发性纤维肌痛综合征 (FMS) 的患病率和影响.
主要方法:
- 关于炎症性关节炎疼痛机制的当前文献的综述.
- 对细胞因子参与和JAK-STAT通路在疼痛调节中的分析.
- 考虑中心敏感性和并发性疾病,如纤维肌痛.
主要成果:
- 在RA中,慢性疼痛涉及的过程超出了炎症和结构损伤,包括神经性炎症和中央敏感化.
- 纤维肌痛综合征 (FMS) 在RA患者中很常见,并导致持续的疼痛,受抑郁症和睡眠障碍的影响.
- 简氏激酶 (JAK) 抑制剂在减少残留的RA疼痛方面表现出有效性,独立于抗炎作用.
结论:
- 在RA的残留疼痛是复杂的,涉及非炎症和中央机制,并经常加剧伴随性FMS.
- 准确诊断并发性FMS对于有效的疼痛管理在RA至关重要.
- 雅克抑制剂为RA的残留疼痛提供了潜在的治疗策略,表明了新的疼痛调节效应.
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