Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
Age Ageing. 2013 May;42(3):272-8. doi: 10.1093/ageing/aft043. Epub 2013 Apr 8.
Osteoarthritis (OA) is the most common type of arthritis worldwide and rapidly increasing with ageing populations. It is a major source of pain and disability for individuals and economic burden for health economies. Modern imaging, in particular magnetic resonance imaging (MRI), has helped us to understand that OA is a dynamic remodelling process involving all the structures within the joint. Inflammation is common in OA, with a high prevalence of synovitis seen on imaging, and this has been associated with joint pain. MRI detected changes within the subchondral bone are also common and associated with pain and structural progression. Targeting individual pathologies may offer potential new therapeutic options for OA; this is particularly important given the current treatments are often limited by side effects or lack of efficacy. New approaches to understanding the pathology and pain pathways in OA offer hope of novel analgesic options, for example, monoclonal antibodies against nerve growth factor and centrally acting drugs such as duloxetine, tapentadol and bradykinin receptor antagonists have all recently undergone trials in OA. While treatment for OA has until now relied on symptom management, for the first time, recent trials suggest that structure modification may be possible by treating the subchondral bone.
骨关节炎（OA）是全球最常见的关节炎类型，随着人口老龄化迅速增加。它是个人疼痛和残疾的主要来源，也是卫生经济的经济负担。现代影像学，特别是磁共振成像（MRI），帮助我们了解到 OA 是一个涉及关节内所有结构的动态重塑过程。OA 中常见炎症，影像学上可见滑膜炎症的高患病率，这与关节疼痛有关。MRI 检测到的软骨下骨内变化也很常见，并与疼痛和结构进展有关。针对个体病变可能为 OA 提供潜在的新治疗选择；鉴于目前的治疗方法通常因副作用或疗效不佳而受到限制，这一点尤其重要。对 OA 病理和疼痛途径的新研究方法为新的镇痛选择带来了希望，例如，针对神经生长因子的单克隆抗体和中枢作用药物，如度洛西汀、曲马多和缓激肽受体拮抗剂，最近都在 OA 中进行了试验。虽然 OA 的治疗迄今为止依赖于症状管理，但最近的试验首次表明，通过治疗软骨下骨，可能有可能改变结构。
