Commonwealth Honors College University of Massachusetts Amherst, Amherst, MA, 01003, USA.
Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
Curr Osteoporos Rep. 2018 Oct;16(5):603-610. doi: 10.1007/s11914-018-0473-5.
Pain in rheumatoid arthritis (RA) may be due to different etiologies, ranging from peripheral inflammation to dysregulation of central nervous system (CNS) processing. This review evaluates relevant literature published on RA pain mechanisms in recent years.
Despite successes of disease-modifying antirheumatic drugs (DMARDs), pain persists for many RA patients. Studies involving patient-reported outcomes, quantitative sensory testing, and neuroimaging indicate that, in addition to joint inflammation, abnormalities in CNS pain processing may contribute to pain. Some DMARDs (e.g., janus kinus inhibitors) may work via multiple pathways to decrease pain. Adjunctive treatments (e.g., antidepressants, antiepileptics) may also be useful in managing pain in RA patients with well-controlled disease. Both peripheral and central mechanisms play key roles in the expression of pain in RA. To effectively manage pain, physicians need accurate assessment tools to identify the pathways involved in each patient so that treatments may be appropriately targeted.
类风湿关节炎（RA）的疼痛可能有不同的病因，从外周炎症到中枢神经系统（CNS）处理的失调。本篇综述评估了近年来有关 RA 疼痛机制的相关文献。
尽管疾病修饰抗风湿药物（DMARDs）取得了成功，但许多 RA 患者仍存在疼痛。涉及患者报告的结局、定量感觉测试和神经影像学的研究表明，除了关节炎症外，CNS 疼痛处理异常也可能导致疼痛。一些 DMARDs（如 Janus 激酶抑制剂）可能通过多种途径发挥作用以减轻疼痛。辅助治疗（如抗抑郁药、抗癫痫药）也可能对病情控制良好的 RA 患者的疼痛管理有用。外周和中枢机制均在 RA 疼痛的表达中起关键作用。为了有效管理疼痛，医生需要准确的评估工具来识别每个患者涉及的途径，以便有针对性地进行治疗。
