类风湿关节炎疼痛机制的研究进展

Research progress in pain mechanism of rheumatoid arthritis

疼痛是类风湿关节炎(RA)患者最显著的症状之一,通常认为疼痛是关节炎发展到后期产生的结果。然而,最新的研究表明RA疼痛可能伴随着疾病的整个过程,并且主要由中枢神经因素、外周神经因素、精神因素导致。RA疼痛的外周神经因素涉及多种炎症因子和离子通道,如白介素-6、白介素-17、白介素-1β、肿瘤坏死因子-α、粒细胞-单核细胞集落刺激因子、前列腺素、神经肽、钙通道、TRPV通道、酸敏感离子通道;RA中枢疼痛的机制主要是中枢神经系统的失调导致;而精神因素,如焦虑、抑郁、失眠、疲劳也会导致疼痛。严重的慢性关节痛是影响RA患者生存状态的重要因素,针对疼痛的治疗是改善患者生活质量的关键。故本文针对RA诱发的疼痛所涉及中枢神经、外周神经和精神因素的机制研究进展作一综述。

Pain is one of the most prominent symptoms in rheumatoid arthritis(RA)patients,and is generally considered the result of arthritis development to later stages.However,latest research shows that RA pain may occur in the entire process of the disease,and is mainly caused by central factors,peripheral factors,and mental factors.The peripheral factors of RA pain involve a variety of inflammatory factors and ion channels,such as interleukin-6,interleukin-17,interleukin-1β,tumor necrosis factor-α,granulocyte-monocyte colony-stimulating factor,prostaglandins,neuropeptides,calcium channels,TRPV channels,and acid-sensitive ion channels.The central pain mechanism of RA is mainly caused by disorders of the central nervous system.Mental factors such as anxiety,depression,insomnia,and fatigue can also cause pain.Severe chronic joint pain is an important factor affecting the survival of RA patients.The treatment of pain is key to improving the quality of life of patients.This article reviews the research progress in the mechanism of central,peripheral and mental factors involved in the pain of RA patients.