Berghea Florian, Berghea Camelia Elena, Zaharia Dumitru, Trandafir Andreea Iulia, Nita Elena Cristina, Vlad Violeta Maria
Department of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Sf. Maria Hospital, Bucharest, Romania.
Front Med (Lausanne). 2021 Aug 17;8:712645. doi: 10.3389/fmed.2021.712645. eCollection 2021.
For many years, inflammatory rheumatic diseases (IRDs) represented a source of disappointment in medical care caused by the mediocre efficacy of the available treatments. Some of these diseases, like Rheumatoid Arthritis (RA) or Ankylosing Spondylitis (AS), caused fear in the general population, especially due to associated joint deformities and subsequent disabilities. However, in the last 20 years, a new successful class of antirheumatic drugs has become available: biologic Disease-Modifying Antirheumatic Drugs (bDMARDs). Due to this innovative treatment, the days are over when joint and spine deformities defined the condition of a person with RA or AS. Nonetheless, expectations are higher today, and other clinical problems, (not entirely solved by bDMARDs), seem to drive the drug selection during the span of rheumatic diseases. Most of these issues are covered by the term "unmet needs." One of the most intriguing of such needs is the residual pain (RP) in patients that are otherwise in the biological remission of the disease. Present in a significant proportion of the patients that enter remission status, RP is poorly understood and managed. In recent years, new data has become available in this area and new conceptual clarifications have occurred. In this review, we explain the various nature of RP and the necessity of treatment diversification in such situations. All in all, we believe this condition is far more complex than simple pain and includes other clinical aspects, too (like fatigue or mood changes) so the terms Post-Remission Syndrome (PRS), and PRS pain might be more appropriate.
多年来，炎性风湿性疾病（IRDs）一直是医疗护理中的一个令人失望的来源，因为现有治疗方法的疗效平平。其中一些疾病，如类风湿关节炎（RA）或强直性脊柱炎（AS），在普通人群中引发了恐惧，尤其是由于相关的关节畸形和随后的残疾。然而，在过去20年里，一类新的成功的抗风湿药物问世了：生物性改善病情抗风湿药物（bDMARDs）。由于这种创新疗法，由关节和脊柱畸形来界定RA或AS患者病情的日子已经一去不复返了。尽管如此，如今人们的期望更高了，而其他临床问题（bDMARDs并未完全解决这些问题）似乎在风湿性疾病的治疗过程中推动着药物的选择。这些问题大多被“未满足的需求”这一术语所涵盖。这类需求中最引人关注的之一是疾病处于生物缓解状态的患者的残留疼痛（RP）。RP存在于相当一部分进入缓解状态的患者中，目前对其了解和管理都很不足。近年来，该领域有了新的数据，也出现了新的概念性阐释。在本综述中，我们解释了RP的各种性质以及在这种情况下治疗多样化的必要性。总而言之，我们认为这种情况远比单纯的疼痛复杂，还包括其他临床方面（如疲劳或情绪变化），因此缓解后综合征（PRS）以及PRS疼痛这两个术语可能更合适。
