Krembil Research Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, 62 Dr Gharib Street, Keshavarz Boulevard, Tehran 14194, Iran.
Nat Rev Rheumatol. 2017 Jul;13(7):410-420. doi: 10.1038/nrrheum.2017.92. Epub 2017 Jun 15.
Clinicians have commonly differentiated chronic back pain into two broad subsets: namely, non-inflammatory (or mechanical) back pain and inflammatory back pain. As the terminology suggests, the latter category, in which ankylosing spondylitis (AS) is prominent, presupposes a close link between pain and inflammation. Advances in research into the genetics and immunology of AS have improved our understanding of the inflammatory processes involved in this disease, and have led to the development of potent anti-inflammatory biologic therapeutic agents. However, evidence from clinical trials and from biomarker and imaging studies in patients with AS indicate that pain and inflammation are not always correlated. Thus, the assumption that pain in AS is a reliable surrogate marker for inflammation might be an over-simplification. This Review provides an overview of current concepts relating to neuro-immune interactions in AS and summarizes research that reveals an increasingly complex interplay between the activation of the immune system and pain pathways in the nervous system. The different types of pain experienced by patients with AS, insights from brain imaging studies, neurological mechanisms of pain, sex bias in pain and how the immune system can modify pain in patients with AS are also discussed.
非炎症性（或机械性）背痛和炎症性背痛。顾名思义，后者（强直性脊柱炎（AS）较为突出）假设疼痛和炎症之间存在密切联系。对 AS 的遗传学和免疫学的研究进展提高了我们对该病炎症过程的认识，并导致了强效抗炎生物治疗药物的发展。然而，来自 AS 患者的临床试验和生物标志物及影像学研究的证据表明，疼痛和炎症并不总是相关的。因此，AS 中的疼痛是炎症的可靠替代标志物这一假设可能过于简单。这篇综述概述了与 AS 中的神经-免疫相互作用相关的当前概念，并总结了揭示免疫系统激活与神经系统疼痛途径之间日益复杂相互作用的研究。还讨论了 AS 患者经历的不同类型的疼痛、脑成像研究的见解、疼痛的神经机制、疼痛中的性别偏见以及免疫系统如何在 AS 患者中改变疼痛。
