Department of Physical Medicine and Rehabilitation, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA.
PM R. 2011 Jun;3(6 Suppl 1):S39-44. doi: 10.1016/j.pmrj.2011.04.023.
More than one in 4 Americans has a musculoskeletal (MSK) disorder that requires medical diagnosis and treatment. Imaging tools are able to demonstrate structural changes but cannot reflect the disease activity or symptom severity of MSK conditions. This is of paramount concern in the aging population, in which imaging findings have poor correlation with symptoms, and multiple pain generators frequently coexist. Because levels of inflammatory and matrix breakdown products address disease activity, evaluation of biomarkers has the potential to provide assessment of active pain generators above and beyond the changes observable on imaging studies. This fact has stimulated research interest in the search for novel biomarkers of disease activity and response to treatment in body fluids. The goal is to develop panels of multi-biomarkers, which could be used independently or in conjunction with the imaging tools, for the diagnosis, prognosis, and treatment validation in MSK diseases. The current review of MSK biomarkers is organized into 3 mechanistic categories: the metabolites of extracellular matrix of MSK tissues; inflammatory cytokines and chemokines; and pain-related neuropeptides and/or chemicals. Although some representative biomarkers could be used alone, the fact that MSK diseases are multi-tissue disorders that involve the muscles, bones, cartilage, and nerves suggests that panels of biomarkers may have greater potential than any single biomarker used in isolation. As advances in biotechnology make this a reality, multi-biomarker panels that include all 3 categories of biomarkers, used either alone or in combination with imaging tools, has the potential to revolutionize the clinical approach to MSK diseases.
超过四分之一的美国人患有需要医学诊断和治疗的肌肉骨骼（MSK）疾病。成像工具能够显示结构变化，但不能反映 MSK 疾病的疾病活动或症状严重程度。这在老龄化人口中尤为重要，因为影像学发现与症状相关性差，并且多个疼痛发生器经常共存。由于炎症和基质分解产物的水平反映了疾病活动，因此评估生物标志物有可能提供对成像研究中观察到的变化之外的活跃疼痛发生器的评估。这一事实激发了人们对在体液中寻找疾病活动和治疗反应的新型生物标志物的研究兴趣。目标是开发多生物标志物的组合，这些标志物可以单独使用或与成像工具结合使用，用于 MSK 疾病的诊断、预后和治疗验证。目前对 MSK 生物标志物的综述分为 3 个机制类别：MSK 组织细胞外基质的代谢物；炎症细胞因子和趋化因子；以及与疼痛相关的神经肽和/或化学物质。尽管一些有代表性的生物标志物可以单独使用，但 MSK 疾病是多组织疾病，涉及肌肉、骨骼、软骨和神经，这表明生物标志物组合可能比任何单独使用的单一生物标志物具有更大的潜力。随着生物技术的进步，包括所有 3 个类别的生物标志物的多生物标志物组合，无论是单独使用还是与成像工具结合使用，都有可能彻底改变 MSK 疾病的临床治疗方法。
