ANALYSIS OF THE PATHOGENETIC MECHANISMS OF CHRONIC JOINT PAIN IN PATIENTS WITH RHEUMATOID ARTHRITIS AND KNEE OSTEOARTHRITIS
https://doi.org/10.14412/1995-4484-2014-631-635
Abstract
Objective: to reveal neurogenic mechanisms in the pathogenesis of chronic pain syndrome in rheumatoid arthritis (RA) and knee osteoarthritis (OA) in order to develop individualized pharmacotherapy.
Subjects and methods. One hundred and eighty-three patients with RA and 80 with knee OA were examined. By using the neuropathic pain diagnostic questionnaire (DN4), all the patients were divided into 2 groups with and without a neuropathic pain component (NPC).
Results. NPC was found in 43% of the patients with RA and it was connected with involvement of the peripheral somatosensory system. In RA, NPC was common in older patients with longer disease duration, higher X-ray stage, and severe functional insufficiency. 30% of patients with knee OA also had NPC, however the signs of nervous system involvement were absent. In OA, NPC was associated with hyperalgesia, higher pain intensity, more marked joint dysfunction on the WOMAC, and anxiety.
Discussion. This investigation revealed a mixed pattern of chronic pain syndrome in patients with RA and knee OA; some patients were found to have a NPC in the presence of predominantly a nociceptive component
About the Authors
E. S. Filatova
V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
Russian Federation
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
E. F. Turovskaya
V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
Russian Federation
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
8, Trubetskaya St., Build. 2, Moscow 119991
L. I. Alekseeva
V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
Sh. F. Erdes
V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
E. G. Filatova
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
Russian Federation
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991
References
1. Насонов ЕЛ. Ревматоидный артрит как общемедицинская проблема. Терапевтический архив. 2004;76(5):5–7. [Nasonov EL. Rheumatoid arthritis as a general medical problem. Terapevticheskii arkhiv. 2004;76(5):5–7. (In Russ.)]
2. Sany J. Clinical and biological polymorphism of rheumatoid arthritis. Clin Exp Rheum. 1994;12:59–61.
3. Scott DL. Prognostic factors in early rheumatoid arthritis. Rheumatology (Oxford). 2000;39 (Suppl 1):24–9. DOI: http://dx.doi.org/10.1093/oxfordjournals.rheumatology.a031490.
4. Насонов ЕЛ, редактор. Ревматология: клинические рекомендации. 2-е изд., испр. и доп. Москва: ГЭОТАР-Медиа; 2010. 752 с. [Nasonov EL, editor. Revmatologiya: klinicheskie rekomendatsii [Rheumatology: clinical recommendations]. 2nd ed. Moscow: GEOTAR-Media; 2010. 752 p.]
5. Kalk NJ, Schweinhardt P, et al. Functional magnetic resonance imaging of central processing of clinical and experimental pain in rheumatoid arthritis. Abstracts 11th world congress on pain. August 21–26, Sydney: N.S.W.; 2005. P. 108.
6. Gwilym SE, Keltner JR, Warnaby CE, et al. Psychophysical and functional imaging evidence supporting the presence of central sensitization in a cohort of osteoarthritis patients. Arthritis Rheum. 2009;l 61(9):1226–34.
7. Lim AYN, Doherty M. What of guidelines for osteoarthritis? Int J Rheum Dis. 2011;14:136–44. DOI: http://dx.doi.org/10.1111/j.1756-185X.2011.01609.x.
8. Kidd BL, Urban LA. Mechanisms of inflammatory pain. Br J Anaesth. 2001;87:3–11. DOI: http://dx.doi.org/10.1093/bja/87.1.3.
9. Schaible HG, Grubb BD. Afferent and spinal mechanisms of join pain. Pain. 1993;55:5–54. DOI: http://dx.doi.org/10.1016/0304-3959(93)90183-P/
10. Schaible HG, Ebersberger A, von Banchet GS. Mechanisms of pain in arthritis. Ann N Y Acad Sci. 2002:966:343–54. DOI: http://dx.doi.org/10.1111/j.1749-6632.2002.tb04234.x.
11. Данилов АБ, Давыдов ОС. Нейропатическая боль. Москва: БОРГЕС; 2007. 198 с. [Danilov AB, Davydov OS. Neiropaticheskaya bol' [Neyropathic pain]. Moscow: BORGES; 2007. 198 p.]
12. Mazanec DJ, DeMicco RC. Osteoarthritis and Rheumatoid arthritis. Current Diagnosis&Treatment. Pain (Medical Books/McGraw-Hill). 2005;14;209–26.
13. Rowbotham M, Kidd BI, Porreca F. Role of central sensitization in chronic pain: Ostesarthritis and rheumadoid arthritis compared to neuropathic pain. 11th Wold Congress on pain. Sydney: N.S.W.; 2005. P. 231–50.
14. Buvanendran A. Pregabalin decreases pain and improves mobility after knee replacement. American Society of Anesthesiologists. 2007. 15 Oct.
15. Ohtori S, Inoue G, Orita S, et al. Efficacy of combination of meloxicam and pregabalin for pain in knee osteoarthritis. Yonsei Med J. 2013 Sep 1;54(5):1253–8. DOI: http://dx.doi.org/10.3349/ymj.2013.54.5.1253.
16. Attal N, Cruccu G, Haanpaa M, et al. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurology. 2006;13:1153–69. DOI: http://dx.doi.org/10.1111/j.1468-1331.2006.01511.x.
Review
For citations:
Filatova E.S., Turovskaya E.F., Alekseeva L.I., Erdes Sh.F., Filatova E.G. ANALYSIS OF THE PATHOGENETIC MECHANISMS OF CHRONIC JOINT PAIN IN PATIENTS WITH RHEUMATOID ARTHRITIS AND KNEE OSTEOARTHRITIS. Rheumatology Science and Practice. 2014;52(6):631-635. (In Russ.) https://doi.org/10.14412/1995-4484-2014-631-635
Views:
1191
Email this article 