Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute of Health Research Leeds Biomedical Research Centre, Leeds, UK.
The University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Nat Rev Rheumatol. 2019 Jun;15(6):355-363. doi: 10.1038/s41584-019-0221-y.
Pain is the major symptom of osteoarthritis (OA) and is an important factor in strategies to manage this disease. However, the current standard of care does not provide satisfactory pain relief for many patients. The pathophysiology of OA is complex, and its presentation as a clinical syndrome is associated with pathologies of multiple joint tissues. Inflammation is associated with both OA pain and disease outcome and is therefore a major treatment target for OA and OA pain. Unlike TNF inhibitors and IL-1 inhibitors, established drugs such as glucocorticoids and methotrexate can reduce OA pain. Although central nociceptive pathways contribute to OA pain, crosstalk between the immune system and nociceptive neurons is central to inflammatory pain; therefore, new therapies might target this crosstalk. Newly identified drug targets, including neurotrophins and the granulocyte-macrophage colony-stimulating factor (GM-CSF)-CC-chemokine ligand 17 (CCL17) chemokine axis, offer the hope of better results but require clinical validation.
疼痛是骨关节炎（OA）的主要症状，也是管理这种疾病的策略中的一个重要因素。然而，目前的标准治疗方法并不能为许多患者提供满意的止痛效果。OA 的病理生理学非常复杂，其作为临床综合征的表现与多种关节组织的病理学有关。炎症与 OA 疼痛和疾病结局都有关，因此是 OA 和 OA 疼痛的主要治疗靶点。与 TNF 抑制剂和 IL-1 抑制剂不同，地塞米松和甲氨蝶呤等已确立的药物可以减轻 OA 疼痛。尽管中枢伤害感受途径有助于 OA 疼痛，但免疫系统和伤害感受神经元之间的串扰是炎症性疼痛的核心；因此，新的治疗方法可能针对这种串扰。新确定的药物靶点，包括神经营养因子和粒细胞-巨噬细胞集落刺激因子（GM-CSF）-CC 趋化因子配体 17（CCL17）趋化因子轴，为更好的结果带来了希望，但需要临床验证。
