Non-inflammatory Causes of Pain in Patients with Rheumatoid Arthritis
Non-inflammatory Causes of Pain in Patients with Rheumatoid Arthritis
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DOI：
10.1007/s11926-016-0581-0
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发表时间：
2016-06-01
影响因子：
5
通讯作者：
Lee, Yvonne C.
中科院分区：
文献类型：
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作者：
Boyden, Sean D.;Hossain, Imtiyaz N.;Lee, Yvonne C.
虽然类风湿性关节炎（RA）的疼痛通常被认为是炎症性的，但炎症程度与疼痛强度之间的相关性很低。这种观察结果可能是由于疼痛的多因素性质。除了关节炎症引起的疼痛外，RA患者也可能由于结构损伤或中枢病因引起疼痛，例如中枢神经系统（CNS）疼痛调节通路的异常。这些中枢神经系统通路包括促进疼痛的机制，以及抑制疼痛的机制。其他因素，如睡眠障碍、抑郁、焦虑和灾难化，也可能影响RA患者对疼痛的感知。由于疼痛经常被用作评估类风湿性关节炎疾病活动性的炎症指标，重要的是患者和医生认识到并非所有疼痛都是炎症性的，可能需要考虑替代治疗策略，而不是升级改善疾病的抗风湿药物治疗。
Although pain in rheumatoid arthritis (RA) is frequently thought to be inflammatory in nature, the association between measures of inflammation and pain intensity is low. This observation is likely due to the multifactorial nature of pain. In addition to pain from joint inflammation, RA patients may also have pain due to structural damage or central etiologies, such as aberrancies in the central nervous system (CNS) pain regulatory pathways. These CNS pathways include mechanisms that facilitate pain, as well as mechanisms that inhibit pain. Other factors, such as sleep disturbances, depression, anxiety, and catastrophizing, may also impact the perception of pain in RA patients. Since pain is frequently used as a proxy for inflammation in the assessment of RA disease activity, it is important that patients and physicians recognize that not all pain is inflammatory, and alternative management strategies, other than escalating disease-modifying antirheumatic drug treatment, may need to be considered.