- 作者：Mira Meeus ; PhD?/sup> ; &dagger ; ; Mira.Meeus@vub.ac.be ; Stijn Vervisch ; PT?/sup> ; Luc S. De Clerck ; PhD&Dagger ; ; Greta Moorkens ; PhD§ ; ; Guy Hans ; PhD¶ ; ; Jo Nijs ; PhD?/sup> ; &dagger ; ; ?/sup>
- 关键词：pain inhibition ; chronic pain ; central sensitization ; pain processing ; rheumatoid arthritis ; systematic review
- 刊名：Seminars in Arthritis and Rheumatism
- 出版年：2012
- 出版时间：February 2012
- 年：2012
- 卷：41
- 期：4
- 页码：556-567
- 全文大小：445 K
Objective
The goal of the present study is to systematically review the scientific literature addressing central sensitization and central nociceptive processing in patients with rheumatoid arthritis (RA).Methods
To identify relevant articles, we searched PubMed and Web of Science. The search strategy was a combination of terms of the following groups: ¡°Rheumatoid arthritis,?inflammatory joint pain, or arthritis; AND (central) sensitization, (central) hypersensitivity, central hyperexcitability, pain modulation, pain processing, neural inhibition, or pain physiopathology; AND pain, nociception, hyperalgesia, pain threshold, or algometry. Articles fulfilling the inclusion criteria were screened for methodologic quality with specific checklists to evaluate different study designs (2 independent raters).
Results
Twenty-four full-text articles were included, of which the majority were case-control studies, followed by nonsystematic reviews, cross-sectional studies, and case reports. Methodologic quality was very heterogeneous. Preliminary evidence for generalized hyperalgesia in RA is available. In addition, the mechanism behind impaired central nociceptive processing remains rather obscure. The role of cytokines and neuropeptides especially remains to be elucidated. Windup appears to develop more easily in RA, but evidence in support of impaired nociceptive inhibition and cognitive emotional sensitization (sensitization due to cognitive bias) is scarce.
Conclusions
The symmetrical manifestation of the disease, the poor relation between disease activity and symptoms, and the generalized hyperalgesia at both articular and nonarticular sites for different kinds of stimuli are indicative of the presence of central sensitization in RA patients. Further research is required to provide firm evidence in support of various aspects of central sensitization in humans with RA.