Rheumatology, Newton-Wellesley Hospital, Tufts University School of Medicine, Newton, MA, USA.
Semin Arthritis Rheum. 2010 Aug;40(1):15-31. doi: 10.1016/j.semarthrit.2008.11.005. Epub 2009 Feb 13.
To review the overlap of pain and depression in the rheumatic diseases, focusing on fibromyalgia (FM) and rheumatoid arthritis, and to provide treatment recommendations based on an understanding of this interface.
A literature search was performed through PubMed and Medline, for the years 1978 to 2008 and using the keywords: depression, mood disorders, pain, arthritis, fibromyalgia, rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, scleroderma, antidepressants, exercise, and cognitive behavioral therapy.
This review focuses on the pain/depression interface in common rheumatic disorders. FM is an excellent model to study the proposed mechanisms of such interactions. The potential genetic, inflammatory/immune, morphologic, and neurohormonal mechanisms that have been reported in FM are reviewed and compared with similar studies in depression. The importance of the interface of pain and depression has been noted in rheumatoid arthritis and other rheumatic illnesses, although there are very few studies to investigate their pathophysiologic underpinnings. General therapeutic recommendations can be made based on these overlapping models of the interface of pain and depression.
Clinical and pathophysiologic studies in FM demonstrate the striking overlap of pain and depression. These studies pertain to a better understanding of the pain/depression interface in all chronic rheumatic illnesses.
回顾风湿性疾病中疼痛和抑郁的重叠，重点关注纤维肌痛（FM）和类风湿关节炎，并根据对这一界面的理解提供治疗建议。
通过 PubMed 和 Medline 进行文献检索，检索年限为 1978 年至 2008 年，使用的关键词为：抑郁、情绪障碍、疼痛、关节炎、纤维肌痛、类风湿关节炎、骨关节炎、系统性红斑狼疮、硬皮病、抗抑郁药、运动和认知行为疗法。
本综述重点关注常见风湿性疾病中疼痛/抑郁的界面。FM 是研究这些相互作用的潜在机制的理想模型。本文回顾了已报道的 FM 中潜在的遗传、炎症/免疫、形态和神经激素机制，并与抑郁中的类似研究进行了比较。尽管很少有研究调查其病理生理基础，但在类风湿关节炎和其他风湿性疾病中已经注意到疼痛和抑郁之间的界面的重要性。可以根据这些疼痛和抑郁界面的重叠模型提出一般的治疗建议。
FM 的临床和病理生理研究表明疼痛和抑郁之间存在显著的重叠。这些研究有助于更好地理解所有慢性风湿性疾病中疼痛/抑郁的界面。
