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Ninneman JV, Roberge GA, Stegner AJ, Cook DB. Exercise Training for Chronic Pain: Available Evidence, Current Recommendations, and Potential Mechanisms. Curr Top Behav Neurosci 2024. [PMID: 39120812 DOI: 10.1007/7854_2024_504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Chronic pain conditions pose a significant global burden of disability, with epidemiological data indicating a rising incidence. Exercise training is commonly recommended as a standalone or complementary approach for managing various chronic pain conditions like low back pain, osteoarthritis, rheumatoid arthritis, fibromyalgia syndrome, and neuropathic pain. Regardless of the specific condition or underlying cause (e.g., autoimmune disease, chronic inflammation), exercise training consistently leads to moderate to large reductions in pain. Moreover, exercise yields numerous benefits beyond pain alleviation, including small-to-moderate improvements in disability, quality of life, and physical function. Despite its efficacy, there is a lack of comprehensive research delineating the optimal intensity, duration, and type of exercise for maximal benefits; however, evidence suggests that sustained engagement in regular exercise or physical activity is necessary to achieve and maintain reductions in both clinical pain intensity ratings and the level that pain interferes with activities of daily living. Additionally, the precise mechanisms through which exercise mitigates pain remain poorly understood and likely vary based on the pathophysiological mechanisms underlying each condition.
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Affiliation(s)
- Jacob V Ninneman
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Gunnar A Roberge
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Aaron J Stegner
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Dane B Cook
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA.
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Baerwald C, Stemmler E, Gnüchtel S, Jeromin K, Fritz B, Bernateck M, Adolf D, Taylor PC, Baron R. Predictors for severe persisting pain in rheumatoid arthritis are associated with pain origin and appraisal of pain. Ann Rheum Dis 2024:ard-2023-225414. [PMID: 38816064 DOI: 10.1136/ard-2023-225414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/04/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES To determine the proportion of patients with rheumatoid arthritis (RA) with severe persisting pain and to identify predictive factors despite treatment-controlled disease activity. METHODS This prospective multicentre study included outpatients with RA scheduled for escalation of anti-inflammatory treatment due to active disease and severe pain (Disease Activity Score 28 (DAS28)>3.2 and Visual Analogue Scale (VAS)>50). At week 24, patients were stratified into reference group (DAS28 improvement>1.2 or DAS28≤3.2 and VAS pain score<50), non-responders (DAS28 improvement≤1.2 and DAS28>3.2, regardless of VAS pain score) and persisting pain group (DAS28 improvement>1.2 or DAS28≤3.2 and VAS pain score≥50). The former two subgroups ended the study at week 24. The latter continued until week 48. Demographic data, DAS28-C reactive protein, VAS for pain, painDETECT Questionnaire (PD-Q) to identify neuropathic pain (NeP) and the Pain Catastrophising Scale were assessed and tested for relation to persisting pain. RESULTS Of 567 patients, 337 (59.4%) were classified as reference group, 102 (18.0%) as non-responders and 128 (22.6%) as patients with persisting pain. 21 (8.8%) responders, 28 (35.0%) non-responders and 27 (26.5%) persisting pain patients tested positive for NeP at week 24. Pain catastrophising (p=0.002) and number of tender joints (p=0.004) were positively associated with persisting pain at week 24. Baseline PD-Q was not related to subsequent persisting pain. CONCLUSIONS Persisting and non-nociceptive pain occur frequently in RA. Besides the potential involvement of NeP, pain catastrophising and a higher number of tender joints coincide with persisting pain.
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Affiliation(s)
- Christoph Baerwald
- Zentrum für Seltene Erkrankungen, University Hospital Leipzig, Leipzig, Germany
| | | | | | | | - Björn Fritz
- AbbVie Deutschland GmbH & Co KG, Wiesbaden, Germany
| | | | | | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Ralf Baron
- Department of Neurology, University Hospital Schleswig Holstein, Kiel, Germany
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Xu JP, Ouyang QW, Shao MJ, Ke H, Du H, Xu SC, Yang Q, Cui YR, Qu F. Manual acupuncture ameliorates inflammatory pain by upregulating adenosine A 3 receptor in complete Freund's adjuvant-induced arthritis rats. Int Immunopharmacol 2024; 133:112095. [PMID: 38678668 DOI: 10.1016/j.intimp.2024.112095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/06/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Adenosine A3 receptor (A3R) exerts analgesic, anti-inflammatory, and anti-nociceptive effects. In this study, we determined the analgesic mechanism of manual acupuncture (MA) in rats with complete Freund's adjuvant (CFA)-induced arthritis and explored whether MA ameliorates inflammation in these rats by upregulating A3R. METHODS Sixty Sprague Dawley (SD) rats were randomly divided into the following groups: Control, CFA, CFA + MA, CFA + sham MA, CFA + MA + DMSO, CFA + MA + IB-MECA, and CFA + MA + Reversine groups. The arthritis rat model was induced by injecting CFA into the left ankle joints. Thereafter, the rats were subjected to MA (ST36 acupoint) for 3 days. The clinical indicators paw withdrawal latency (PWL), paw withdrawal threshold (PWT), and open field test (OFT) were used to determine the analgesic effect of MA. In addition, to explore the effect of A3R on inflammation after subjecting arthritis rats to MA, IB-MECA (A3R agonist) and Reversine (A3R antagonist) were injected into ST36 before MA. RESULTS MA ameliorated the pathological symptoms of CFA-induced arthritis, including the pain indicators PWL and PWT, number of rearing, total ambulatory distance, and activity trajectory. Furthermore, after MA, the mRNA and protein expression of A3R was upregulated in CFA-induced arthritis rats. In contrast, the protein levels of TNF-α, IL-1β, Rap1, and p-p65 were downregulated after MA. Interestingly, the A3R agonist and antagonist further downregulated and upregulated inflammatory cytokine expression, respectively, after MA. Furthermore, the A3R antagonist increased the degree of ankle swelling after MA. CONCLUSION MA can alleviate inflammatory pain by inhibiting the NF-κB signaling pathway via upregulating A3R expression of the superficial fascia of the ST36 acupoint site in CFA-induced arthritis rats.
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Affiliation(s)
- Jing-Ping Xu
- Department of Physiology, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi 330004, China
| | - Qian-Wen Ouyang
- Nanchang People's Hospital, Jiangxi Province Key Laboratory for Breast Diseases, Nanchang, Jiangxi 334000, China
| | - Mei-Juan Shao
- Department of Pharmacology, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi 330004, China
| | - Hong Ke
- Department of Physiology, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi 330004, China
| | - Hong Du
- Department of Pharmacology, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi 330004, China
| | - Shang-Cheng Xu
- Department of Pharmacology, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi 330004, China
| | - Qian Yang
- Department of Pharmacology, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi 330004, China
| | - Yan-Ru Cui
- Department of Physiology, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi 330004, China.
| | - Fei Qu
- Department of Pharmacology, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi 330004, China.
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Panagiotopoulos A, Thomas K, Argyriou E, Chalkia A, Kapsala N, Koutsianas C, Mavrea E, Petras D, Boumpas DT, Vassilopoulos D. Health-related quality of life in patients with ANCA vasculitides compared to rheumatoid arthritis: a cross-sectional comparative study. Rheumatology (Oxford) 2024; 63:399-406. [PMID: 37171857 PMCID: PMC10836997 DOI: 10.1093/rheumatology/kead214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES There are limited data regarding health-related quality of life (HRQoL) in patients with ANCA-associated vasculitides (AAVs). We aimed to evaluate the HRQoL in patients with AAVs and compare it to another chronic inflammatory disease like RA and to healthy controls (HC). METHODS This was a multicentre, cross-sectional study of patients with AAVs and RA recruited from three tertiary rheumatology clinics. HRQoL was assessed with the Short Form 36 Health Survey, which included the physical and mental component summary scores (PCS and MCS). Data from 1007 HC served as historical controls. RESULTS Sixty-six patients with AAVs and 71 with RA were included. Both AAV and RA patients had significantly lower PCS and MCS scores compared with HC (P < 0.05). HRQoL in AAV patients was worse in patients with microscopic polyangiitis compared with granulomatosis with polyangiitis (physical components) and those with high (VDI ≥ 3) vs low (VDI < 3) damage scores while it did not differ between those with active (BVASv3 ≥ 1) vs. inactive (BVASv3 < 1) disease. In contrast, in RA patients, HRQoL correlated both with disease activity (assessed by the DAS28-ESR) and functional impairment/damage (assessed by the HAQ). Although overall patients with RA had similar HRQoL compared with those with AAVs, those with active RA had worse HRQoL compared with those with active AAV. CONCLUSIONS In patients with AAVs, HRQoL correlated more with organ damage and less with disease activity whereas in RA patients, it correlated with both. These data emphasize the need for AAV therapies aiming at preventing organ damage and thus improving HRQoL.
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Affiliation(s)
- Alexandros Panagiotopoulos
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, General Hospital of Athens Hippokration, Athens, Greece
| | - Konstantinos Thomas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 4th Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon General Hospital, Athens, Greece
| | | | - Aglaia Chalkia
- Nephrology Department, General Hospital of Athens Hippokration, Athens, Greece
| | - Noemin Kapsala
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 4th Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon General Hospital, Athens, Greece
| | - Christos Koutsianas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, General Hospital of Athens Hippokration, Athens, Greece
| | - Evgenia Mavrea
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, General Hospital of Athens Hippokration, Athens, Greece
| | - Dimitrios Petras
- Nephrology Department, General Hospital of Athens Hippokration, Athens, Greece
| | - Dimitrios T Boumpas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 4th Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon General Hospital, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, General Hospital of Athens Hippokration, Athens, Greece
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Johnson WT, McBride D, Kerr M, Nguyen A, Zoccheddu M, Bollmann M, Wei X, Jones RM, Wang W, Svensson MND, Bottini N, Shah NJ. Immunomodulatory Nanoparticles for Modulating Arthritis Flares. ACS NANO 2024; 18:1892-1906. [PMID: 38016062 DOI: 10.1021/acsnano.3c05298] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Disease-modifying drugs have improved the treatment for autoimmune joint disorders, such as rheumatoid arthritis, but inflammatory flares are a common experience. This work reports the development and application of flare-modulating poly(lactic-co-glycolic acid)-poly(ethylene glycol)-maleimide (PLGA-PEG-MAL)-based nanoparticles conjugated with joint-relevant peptide antigens, aggrecan70-84 and type 2 bovine collagen256-270. Peptide-conjugated PLGA-PEG-MAL nanoparticles encapsulated calcitriol, which acted as an immunoregulatory agent, and were termed calcitriol-loaded nanoparticles (CLNP). CLNP had a ∼200 nm hydrodynamic diameter with a low polydispersity index. In vitro, CLNP induced phenotypic changes in bone marrow derived dendritic cells (DC), reducing the expression of costimulatory and major histocompatibility complex class II molecules, and proinflammatory cytokines. Bulk RNA sequencing of DC showed that CLNP enhanced expression of Ctla4, a gene associated with downregulation of immune responses. In vivo, CLNP accumulated in the proximal lymph nodes after intramuscular injection. Administration of CLNP was not associated with changes in peripheral blood cell numbers or cytokine levels. In the collagen-induced arthritis and SKG mouse models of autoimmune joint disorders, CLNP reduced clinical scores, prevented bone erosion, and preserved cartilage proteoglycan, as assessed by high-resolution microcomputed tomography and histomorphometry analysis. The disease protective effects were associated with increased CTLA-4 expression in joint-localized DC and CD4+ T cells but without generalized suppression of T cell-dependent immune response. The results support the potential of CLNP as modulators of disease flares in autoimmune arthropathies.
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Affiliation(s)
- Wade T Johnson
- Department of NanoEngineering and Chemical Engineering Program, University of California, San Diego, La Jolla, California 92093, United States
| | - David McBride
- Department of NanoEngineering and Chemical Engineering Program, University of California, San Diego, La Jolla, California 92093, United States
| | - Matthew Kerr
- Department of NanoEngineering and Chemical Engineering Program, University of California, San Diego, La Jolla, California 92093, United States
| | - Anders Nguyen
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg 41346, Sweden
- SciLifeLab, University of Gothenburg, Gothenburg 41346, Sweden
| | - Martina Zoccheddu
- Department of Medicine, University of California, San Diego, La Jolla, California 92093, United States
| | - Miriam Bollmann
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg 41346, Sweden
- SciLifeLab, University of Gothenburg, Gothenburg 41346, Sweden
| | - Xiaofu Wei
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, California 92093, United States
| | - Ryan M Jones
- Department of NanoEngineering and Chemical Engineering Program, University of California, San Diego, La Jolla, California 92093, United States
| | - Wei Wang
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, California 92093, United States
- Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, California 92093, United States
| | - Mattias N D Svensson
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg 41346, Sweden
- SciLifeLab, University of Gothenburg, Gothenburg 41346, Sweden
| | - Nunzio Bottini
- Kao Autoimmunity Institute and Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California 90048, United States
| | - Nisarg J Shah
- Department of NanoEngineering and Chemical Engineering Program, University of California, San Diego, La Jolla, California 92093, United States
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Marín-Prida J, Rodríguez-Ulloa A, Besada V, Llopiz-Arzuaga A, Batista NV, Hernández-González I, Pavón-Fuentes N, Marciano Vieira ÉL, Falcón-Cama V, Acosta EF, Martínez-Donato G, Cervantes-Llanos M, Lingfeng D, González LJ, Fernández-Massó JR, Guillén-Nieto G, Pentón-Arias E, Amaral FA, Teixeira MM, Pentón-Rol G. The effects of Phycocyanobilin on experimental arthritis involve the reduction in nociception and synovial neutrophil infiltration, inhibition of cytokine production, and modulation of the neuronal proteome. Front Immunol 2023; 14:1227268. [PMID: 37936684 PMCID: PMC10627171 DOI: 10.3389/fimmu.2023.1227268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/02/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction The antinociceptive and pharmacological activities of C-Phycocyanin (C-PC) and Phycocyanobilin (PCB) in the context of inflammatory arthritis remain unexplored so far. In the present study, we aimed to assess the protective actions of these compounds in an experimental mice model that replicates key aspects of human rheumatoid arthritis. Methods Antigen-induced arthritis (AIA) was established by intradermal injection of methylated bovine serum albumin in C57BL/6 mice, and one hour before the antigen challenge, either C-PC (2, 4, or 8 mg/kg) or PCB (0.1 or 1 mg/kg) were administered intraperitoneally. Proteome profiling was also conducted on glutamate-exposed SH-SY5Y neuronal cells to evaluate the PCB impact on this key signaling pathway associated with nociceptive neuronal sensitization. Results and discussion C-PC and PCB notably ameliorated hypernociception, synovial neutrophil infiltration, myeloperoxidase activity, and the periarticular cytokine concentration of IFN-γ, TNF-α, IL-17A, and IL-4 dose-dependently in AIA mice. In addition, 1 mg/kg PCB downregulated the gene expression for T-bet, RORγ, and IFN-γ in the popliteal lymph nodes, accompanied by a significant reduction in the pathological arthritic index of AIA mice. Noteworthy, neuronal proteome analysis revealed that PCB modulated biological processes such as pain, inflammation, and glutamatergic transmission, all of which are involved in arthritic pathology. Conclusions These findings demonstrate the remarkable efficacy of PCB in alleviating the nociception and inflammation in the AIA mice model and shed new light on mechanisms underlying the PCB modulation of the neuronal proteome. This research work opens a new avenue to explore the translational potential of PCB in developing a therapeutic strategy for inflammation and pain in rheumatoid arthritis.
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Affiliation(s)
- Javier Marín-Prida
- Center for Research and Biological Evaluations, Institute of Pharmacy and Food, University of Havana, Havana, Cuba
| | - Arielis Rodríguez-Ulloa
- Division of Biomedical Research, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Vladimir Besada
- Division of Biomedical Research, Center for Genetic Engineering and Biotechnology, Havana, Cuba
- China-Cuba Biotechnology Joint Innovation Center (CCBJIC), Yongzhou Zhong Gu Biotechnology Co. Ltd, Yongzhou, China
| | - Alexey Llopiz-Arzuaga
- Division of Biomedical Research, Center for Genetic Engineering and Biotechnology, Havana, Cuba
- Department of Cellular Engineering and Biocatalysis , Institute of Biotechnology, National Autonomous University of Mexico (UNAM), Cuernavaca, Mexico
| | - Nathália Vieira Batista
- Laboratory of Immunopharmacology, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Nancy Pavón-Fuentes
- Immunochemical Department, International Center for Neurological Restoration (CIREN), Havana, Cuba
| | - Érica Leandro Marciano Vieira
- Translational Psychoneuroimmunology Group, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Viviana Falcón-Cama
- Division of Biomedical Research, Center for Genetic Engineering and Biotechnology, Havana, Cuba
- Departments of Physiological or Morphological Sciences, Latin American School of Medicine (ELAM), Havana, Cuba
| | - Emilio F. Acosta
- Department of Characterization, Center for Advanced Studies of Cuba, Havana, Cuba
| | - Gillian Martínez-Donato
- Division of Biomedical Research, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Majel Cervantes-Llanos
- Division of Biomedical Research, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Dai Lingfeng
- China-Cuba Biotechnology Joint Innovation Center (CCBJIC), Yongzhou Zhong Gu Biotechnology Co. Ltd, Yongzhou, China
| | - Luis J. González
- Division of Biomedical Research, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | | | - Gerardo Guillén-Nieto
- Division of Biomedical Research, Center for Genetic Engineering and Biotechnology, Havana, Cuba
- Departments of Physiological or Morphological Sciences, Latin American School of Medicine (ELAM), Havana, Cuba
| | - Eduardo Pentón-Arias
- Division of Biomedical Research, Center for Genetic Engineering and Biotechnology, Havana, Cuba
- Departments of Physiological or Morphological Sciences, Latin American School of Medicine (ELAM), Havana, Cuba
| | - Flávio Almeida Amaral
- Laboratory of Immunopharmacology, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mauro Martins Teixeira
- Laboratory of Immunopharmacology, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Giselle Pentón-Rol
- Division of Biomedical Research, Center for Genetic Engineering and Biotechnology, Havana, Cuba
- Departments of Physiological or Morphological Sciences, Latin American School of Medicine (ELAM), Havana, Cuba
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Manning-Bennett AT, Hopkins AM, Sorich MJ, Proudman SM, Foster DJR, Abuhelwa AY, Wiese MD. The association of depression and anxiety with treatment outcomes in patients with rheumatoid arthritis - a pooled analysis of five randomised controlled trials. Ther Adv Musculoskelet Dis 2022; 14:1759720X221111613. [PMID: 35898566 PMCID: PMC9310212 DOI: 10.1177/1759720x221111613] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is an inflammatory autoimmune condition associated
with an increased risk of developing depression and anxiety. Depression and
anxiety are associated with worse outcomes in RA, but the magnitude of the
effect of each condition on RA outcomes is unclear. It is also unknown how
pharmacological treatment of depression affects RA outcomes. Objective: The primary aim of this study was to investigate the association of comorbid
depression and anxiety with remission in patients with RA. Secondary aims
were to determine the association between comorbid depression and anxiety on
patient-reported outcomes and the relationship between concomitant use of
antidepressants and remission in patients with depression. Design: Data from patients with moderate to severe RA were pooled from five
randomised controlled trials investigating tocilizumab and conventional
synthetic disease-modifying agents. Methods: Remission was defined as a clinical disease activity index (CDAI) of ⩽2.8 and
simple disease activity index (SDAI) of ⩽3.3. The association between the
time to reach remission and depression and anxiety was analysed using Cox
proportional hazard analysis. Results: Individual patient data were available from 5502 subjects, of whom 511 had
depression, 236 had anxiety and 387 were using antidepressants. Depression
was significantly associated with reduced remission [adjusted HR (95% CI):
0.62 (0.48–0.80), p < 0.001 and adjusted HR (95% CI):
0.59 (0.44–0.79), p < 0.001] using CDAI and SDAI,
respectively. Depression was associated with a lower likelihood of achieving
more subjective outcomes (⩽1 physician global assessment, ⩽1 patient global
assessment) and ⩽1 28-swollen joint count, but not ⩽1 28-tender joint count
or C-reactive protein measurement. Treatment with antidepressants did not
improve outcomes for patients with depression. Anxiety was not significantly
associated with RA remission. Conclusion: Comorbid depression, but not anxiety, was associated with less frequent
remission. Concomitant antidepressant use was not associated with
improvements in RA outcomes in patients with depression.
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Affiliation(s)
- Arkady T Manning-Bennett
- UniSA: Clinical & Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Ashley M Hopkins
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Michael J Sorich
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | | | - David J R Foster
- UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ahmad Y Abuhelwa
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Michael D Wiese
- UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
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8
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Gao W, Shen L, Long DD, Pan TT, Wang D, Chai XQ, Hu SS. Angiotensin II type 2 receptor pharmacological agonist, C21, reduces the inflammation and pain hypersensitivity in mice with joint inflammatory pain. Int Immunopharmacol 2022; 110:108921. [PMID: 35724606 DOI: 10.1016/j.intimp.2022.108921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 11/15/2022]
Abstract
Primary and secondary hyperalgesia develop in response to chronic joint inflammation due to peripheral and central mechanisms. Synovial macrophage and spinal microglia are involved in pain sensitization in arthritis. The level of angiotensin II type 2 receptor (AT2R) is related to the severity of arthritis. This study aimed to determine the role of AT2R in primary and secondary hyperalgesia in joint inflammatory pain in mice. After intra-articular CFA injection, primary hyperalgesia in the ipsilateral knee joint was measured by pressure application meter and gait analysis, secondary hypersensitivity in ipsilateral hind-paw was measured by von-Frey and Hargreaves tests following a combination of global AT2R-deficient (Agtr2-/-) mice and AT2R pharmacological agonist C21. Synovial macrophage and spinal microglia were collected for flow cytometry. Morphological reconstruction of microglia was detected by immunostaining. AT2R expression was investigated by quantitative polymerase chain reaction and western blot. Neuronal hyperactivity was evaluated by c-Fos and CGRP immunostaining. We found that pain hypersensitivity and synovial inflammation in Agtr2-/- mice were significantly exacerbated compared with wild-type mice; conversely, systemically administrated C21 attenuated both of the symptoms. Additionally, spinal microglia were activated, and an abundant increase of spinal AT2R was expressed on activated microglia in response to peripheral joint inflammation. Intrathecally-administrated C21 reversed the secondary hypersensitivity, accompanied by alleviation of spinal microglial activation, spinal neuronal hyperactivity, and calcitonin gene-related peptide content. These findings revealed a beneficial role of AT2R activating stimulation against pain hypersensitivity in joint inflammatory pain via direct modulation of synovial macrophage and spinal microglial activity.
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Affiliation(s)
- Wei Gao
- Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Liang Shen
- Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Medical University, Hefei 230036, China
| | - Dan-Dan Long
- Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Medical University, Hefei 230036, China
| | - Ting-Ting Pan
- Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Medical University, Hefei 230036, China
| | - Di Wang
- Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Medical University, Hefei 230036, China
| | - Xiao-Qing Chai
- Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.
| | - Shan-Shan Hu
- Department of Clinical Laboratory, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China.
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9
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Gupta S, Gautam S, Kumar U, Arora T, Dada R. Potential Role of Yoga Intervention in the Management of Chronic Non-malignant Pain. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:5448671. [PMID: 35668780 PMCID: PMC9167073 DOI: 10.1155/2022/5448671] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/18/2022] [Accepted: 05/13/2022] [Indexed: 12/22/2022]
Abstract
Pain is an unpleasant and upsetting experience. Persistent pain has an impact on an individual's quality of life which causes stress and mood disorders. There are currently no pain-relieving techniques available that can eliminate pain and offer relief without causing any adverse effects. These factors draw attention to traditional treatments like yoga and meditation, which can reduce biological stress and hence increase immunity, as well as alleviate the psychological and emotional suffering produced by pain. Yoga reduces the stress response and the pain cascade via the downregulation of the hypothalamus-pituitary-adrenal (HPA) axis and vagal stimulation. Yoga is a cost-effective growing health practice that, unlike pharmaceuticals, has no side effects and can help patients stay in remission for longer periods of time with fewer relapses. Yoga not only reduces stress and depression severity but also improves functional status and reduces pain perception. This article highlights the impact of yoga on pain management and on a malfunctioning immune system, which leads to improved health, pain reduction, disease management, and improvement in overall quality of life.
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Affiliation(s)
- Shivani Gupta
- Laboratory for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Gautam
- Laboratory for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Uma Kumar
- Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India
| | - Taruna Arora
- Division of Reproductive Biology, Maternal & Child Health, Indian Council of Medical Research, New Delhi, India
| | - Rima Dada
- Laboratory for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
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Candela V, Aimino R, Mezzaqui L, Standoli JP, Gumina S. Macroscopic aspects of glenohumeral synovitis are related to rotator cuff tear severity. J Shoulder Elbow Surg 2022; 31:1055-1061. [PMID: 34871731 DOI: 10.1016/j.jse.2021.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/23/2021] [Accepted: 10/30/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The microscopic pattern of inflammatory mediators associated with rotator cuff pathology is well documented; however, little is known regarding the contemporary presence of macroscopic inflammatory joint involvement. Our aim was to investigate shoulder synovitis in a large group of patients with different sized rotator cuff tears (RCTs) and to correlate the degree of macroscopic inflammatory changes of the glenohumeral joint with RCT severity. MATERIALS AND METHODS A total of 296 consecutive patients (169 F, 127 M; mean age ± standard deviation: 60.75 ± 7.91) submitted to arthroscopic RCT repair were enrolled. RCT was classified intraoperatively. Glenohumeral synovitis was investigated according to 4 parameters (Davis classification 2017: capsule color, villous projections, capillaries, and axillary recess). A total score was calculated, and a 3-grade severity scale was introduced. Statistics was performed. RESULTS Intraclass correlation coefficient (ICC) results show good to excellent reliability: capsule color (ICC: 0.95; 95% confidence interval [CI]: 0.89-0.99), villous projections (ICC: 0.90; 95% CI: 0.85-0.95), capillaries (ICC: 0.91; 95% CI: 0.86-0.95), and axillary recess (ICC: 0.55; 95% CI: 0.80-0.89).The synovitis total score was found to be 1.47 ± 1.16, 2.86 ± 1.84, and 3.99 ± 1.64 in patients with type I, II, and III RCTs, respectively. A significant difference was found between groups (P < .001). The prevalence of all the examined parameters was found to be significantly different between the different sized RCT groups (capsule color: P < .001; villous projections: P < .001; capillaries: P < .001; and axillary recess: P < .001). According to a 3-grade severity scale, the prevalence of absent, mild, and severe glenohumeral synovitis significantly differed between the RCT severity groups (P < .001). CONCLUSIONS The present study demonstrated that synovitis is a constant finding of rotator cuff pathology; it is present in 75% of patients with RCTs and correlates with tear severity. Whether synovitis is the cause or effect of RCT is still questionable. Further studies are also needed to better understand its role as a pain generator, as documented in other diseases.
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Affiliation(s)
- Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy; Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy.
| | - Rossana Aimino
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy; Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Lorenzo Mezzaqui
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy; Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Jacopo Preziosi Standoli
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy; Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
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Healthcare Professionals' Compliance with the Standard Management Guidelines towards the Use of Biological Disease-Modifying Anti-Rheumatic Drugs in Rheumatoid Arthritis Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084699. [PMID: 35457564 PMCID: PMC9025247 DOI: 10.3390/ijerph19084699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/30/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
Treatment of rheumatoid arthritis (RA) is complicated, with numerous aspects influencing decision-making, including disease severity, comorbidities, and patient preferences. The present study aimed to evaluate healthcare professionals' (HCPs) knowledge of biological disease-modifying anti-rheumatic drugs (bDMARDs) and their compliance with the standard management guidelines for assuring optimal RA therapy. The cross-sectional, survey-based study was performed in various healthcare and academic settings in Karachi, Pakistan to probe HCPs' knowledge of bDMARDs and their compliance with the European League against Rheumatism (EULAR) recommendations for the management of RA patients. Overall, n = 413 questionnaires were included in our study (response rate: 82.6%). The physicians were further well-informed about the indications (n = 276, 91.3%, p = 0.001) and monitoring requirements (n = 258, 85.4%, p = 0.004). The pharmacists were more knowledgeable about the drug targets (n = 96, 86.4%, p = 0.029) and their mechanisms of action (n = 80, 72.0%, p = 0.013). Male respondents as compared with females (41.3% vs. 35.6%, p = 0.04), and physicians as compared with pharmacists (40.7% vs. 37.8%, p = 0.012), were more confident in using bDMARDs than conventional treatment in RA patients. Our findings show that the respondents were familiar with the attributes of bDMARDs and the standard management guidelines for RA care. Our results may be relevant in creating new methods, guidelines, and treatments to enhance RA treatment adherence, satisfaction, and health outcomes.
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Yildirim A, Önder ME, Özkan D. Ultrasonographic evaluation of distal femoral and talar cartilage thicknesses in patients with early rheumatoid arthritis and their relationship with disease activity. Clin Rheumatol 2022; 41:2001-2007. [DOI: 10.1007/s10067-022-06132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/09/2022] [Accepted: 03/13/2022] [Indexed: 11/03/2022]
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Cocores AN, Monteith TS. Headache as a Neurologic Manifestation of Systemic Disease. Curr Treat Options Neurol 2022; 24:17-40. [PMID: 35317303 PMCID: PMC8931180 DOI: 10.1007/s11940-022-00704-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/26/2022]
Abstract
Purpose of Review Recent Findings Summary
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Affiliation(s)
- Alexandra N. Cocores
- Division of Headache, Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14 Street, Florida, Miami 33132 USA
| | - Teshamae S. Monteith
- Division of Headache, Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14 Street, Florida, Miami 33132 USA
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Wang J, Wen W, Gong D, Chen Q, Li P, Liu P, Wang F, Xu S. SZAP exerts analgesic effects on rheumatalgia in CIA rats by suppressing pain hyperalgesia and inhibiting TRPV1 and P2X3. JOURNAL OF ETHNOPHARMACOLOGY 2022; 284:114780. [PMID: 34728318 DOI: 10.1016/j.jep.2021.114780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE ShexiangZhuifeng Analgesic Plaster (SZAP) is a traditional Chinese medicine and transdermal formulation composed of many Chinese herbs and active compounds. SZAP was recently approved by the China Food and Drug Administration for the treatment of pain associated with osteoarticular diseases and is preferred by most rheumatoid arthritis patients in China. However, its mechanism has not been elucidated in detail. AIM OF THE STUDY We sought to determine the analgesic effect of SZAP in collagen-induced arthritis (CIA) rats and explore the underlying mechanisms of pain transmission, such as via the TRPV1 and P2X3 receptors. METHODS After CIA was established, rats were treated with SZAP for 7 days. Paw thickness, arthritis score, and haematoxylin and eosin staining were used to evaluate the effectiveness of SZAP. Paw withdrawal threshold (PWT) and tail-flick latency (TFL) were used to estimate the analgesic effect of SZAP. The levels of PGE2, BK, 5-HT, SP, and CGRP in the serum and synovium were determined using ELISA kits, and ATP in the synovium was measured using HPLC. The expression of TRPV1 and P2X3 in the DRG was detected using western blotting and immunofluorescence. TRPV1 and P2X3 agonists were further used to determine the analgesic effects of SZAP on CIA rats based on PWT and TFL. RESULTS SZAP not only significantly ameliorated arthritis scores and paw thickness by improving the pathological damage of synovial joints, but also remarkably alleviated pain in CIA rats. Further, treatment with SZAP significantly reduced peripheral 5-HT, PGE2 BK, SP, CGRP, and ATP. Additionally, the expression of TRPV1 and P2X3 in the DRG was markedly downregulated by SZAP. Interestingly, the analgesic effect of SZAP was weakened (reduction of PWT and TFL) when TRPV1 and P2X3 were activated by capsaicin or α,β-meATP, respectively. CONCLUSION SZAP ameliorates rheumatalgia by suppressing hyperalgesia and pain transmission through the inhibition of TRPV1 and P2X3 in the DRG of CIA rats.
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Affiliation(s)
- Jie Wang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, PR China; Institute of Meterial Medica Integration and Transformation for Brain Disorders, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, PR China
| | - Wen Wen
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, PR China; Institute of Meterial Medica Integration and Transformation for Brain Disorders, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, PR China
| | - Daoyin Gong
- Department of Pathology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qi Chen
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, PR China; Institute of Meterial Medica Integration and Transformation for Brain Disorders, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, PR China
| | - Ping Li
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, PR China; Institute of Meterial Medica Integration and Transformation for Brain Disorders, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, PR China
| | - Panwang Liu
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, PR China; Institute of Meterial Medica Integration and Transformation for Brain Disorders, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, PR China
| | - Fushun Wang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, Sichuan, 610000, China
| | - Shijun Xu
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, PR China; Institute of Meterial Medica Integration and Transformation for Brain Disorders, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, PR China; State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu, Sichuan, 611137, PR China.
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Sahraei F, Rahemi Z, Sadat Z, Zamani B, Ajorpaz NM, Afshar M, Mianehsaz E. The effect of Swedish massage on pain in rheumatoid arthritis patients: A randomized controlled trial. Complement Ther Clin Pract 2021; 46:101524. [PMID: 34953451 DOI: 10.1016/j.ctcp.2021.101524] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/22/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Joint pain is one of the most common symptoms in rheumatoid arthritis patients and require medical attention. The purpose of this study was to assess the effects of Swedish massage on pain and painkiller consumption in rheumatoid arthritis patients. MATERIALS AND METHODS A total of 60 patients participated in the experiment, with half assigned to the control group (n = 30) and half to the experimental (n = 30) group using the block randomization method. On patients in the experimental group, a 30-min Swedish massage was performed regularly for eight weeks: twice a week for the first four weeks, and three times a week for the last four weeks. The control group received routine care. The visual analogue scale-pain was used to measure pain in the two groups at three points of time: before the beginning of the experiment, immediately after the last session, and one month after the last session of the intervention. RESULTS The analysis of covariance showed that there were significant differences between the two groups' mean scores of pain and painkiller consumption immediately after and one month after the last session of the intervention (p = 0.01). Furthermore, in the experimental group, the mean scores of pain and painkiller consumption decreased over the three points of time (p < 0.05). CONCLUSION Swedish massage can be effective in reducing pain and the need to use painkillers in rheumatoid arthritis patients.
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Affiliation(s)
- Farideh Sahraei
- Trauma Nursing Research Center, Department of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Rahemi
- School of Nursing, Clemson University, South Carolina, 605 Grove Road, Greenville, SC, 29605, USA
| | - Zohreh Sadat
- Trauma Nursing Research Center, Department of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Batool Zamani
- Autoimmune Diseases Research Center, Department of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Neda Mirbagher Ajorpaz
- Autoimmune Diseases Research Center, Department of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran.
| | - Mohamad Afshar
- Trauma Nursing Research Center, Department of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Elaheh Mianehsaz
- Clinical Research Center, Department of Medicine, Kashan University of Medical Sciences, Kashan, Iran
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C-terminal modified Enkephalin-like tetrapeptides with enhanced affinities at the kappa opioid receptor and monoamine transporters. Bioorg Med Chem 2021; 51:116509. [PMID: 34798381 DOI: 10.1016/j.bmc.2021.116509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022]
Abstract
A new series of enkephalin-like tetrapeptide analogs modified at the C-terminus by an N-(3,4-dichlorophenyl)-N-(piperidin-4-yl)propionamide (DPP) moiety were designed, synthesized, and tested for their binding affinities at opioid receptors and monoamine transporters to evaluate their potential multifunctional activity for the treatment of chronic pain. Most ligands exhibited high binding affinities in the nanomolar range at the opioid receptors with a slight delta-opioid receptor (DOR) selectivity over mu-opioid receptor (MOR) and kappa-opioid receptor (KOR) and low binding affinities in the micromolar range at the monoamine transporters, SERT and NET. Ligands of which the positions 1 and 4 were substituted by Dmt and Phe(4-X) residues, respectively, showed the excellent binding affinities at three opioid receptors. Among them, Dmt-d-Tic-Gly-Phe(4-F)-DPP was the most promising considering its excellent opioid affinities, particularly unexpected high binding affinity (Ki = 0.13 nM) at the KOR, and moderate interactions with serotonin/norepinephrine reuptake inhibitors (SNRIs). Docking studies revealed that the ligand was a good fit for the KOR binding pocket (binding score = 8,750).
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Sánchez-Flórez JC, Seija-Butnaru D, Valero EG, Acosta CDPA, Amaya S. Pain Management Strategies in Rheumatoid Arthritis: A Narrative Review. J Pain Palliat Care Pharmacother 2021; 35:291-299. [PMID: 34623946 DOI: 10.1080/15360288.2021.1973647] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Rheumatoid Arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation and progressive deterioration of the joints, which generates pain and stiffness. The origin of this pain is multifactorial, with inflammation, secondary osteoarthritis, as well as central and peripheral sensitization playing important roles in the development. Up to 90.4% of RA patients visit a health professional for severe pain, and despite new therapies and sophisticated treatments, there are a limited number of options for analgesic management. We conducted a narrative review using the Medline and Pubmed search engines for articles in English and Spanish between 2000 and 2021, with the keywords "pain," "rheumatoid arthritis," "non-steroidal anti-inflammatory drugs" (NSAIDs), "opioids," "glucocorticoids," "disease modifying antirheumatic drugs" (DMARDs), "neuromodulators," "antidepressants," and "cannabinoids." The articles describing epidemiology, pathophysiological considerations and current treatments were selected after a screening process carried out by the authors. It was found that DMARDs are the fundamental basis of treatment, since the main mechanism of pain in this entity is inflammation. Nonetheless, a significant number of patients continue to have pain despite optimal treatment. The available evidence for pain management in RA is scarce, however, medications such as NSAIDs, topical capsaicin, weak opioids, and treatments such as joint infiltrations or surgical management, play an important role in its management. We believe more research efforts are needed to optimize analgesic treatment recommendations, however, based on the current existing evidence, we propose a stepwise algorithm in order to properly approach these cases. Key PointsRA is a systemic autoimmune disease characterized by chronic inflammation, in which the main symptom is pain.Pain in RA is multifactorial, with inflammation, secondary osteoarthritis, as well as central and peripheral sensitization playing determining roles.DMARDs are the mainstay of RA treatment, although many patients continue to experience pain despite optimal management.Medications such as glucocorticoids, NSAIDs, topical capsaicin, and weak opioids are key elements when achieving analgesia in RA.Other pharmacological groups such as neuromodulators, antidepressants, muscle relaxants and cannabinoids currently do not have enough evidence to be recommended.
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Affiliation(s)
- Juan Camilo Sánchez-Flórez
- Juan Camilo Sánchez-Flórez, MD, Resident, Pain Management and Palliative Care Department, Hospital Militar Central, Universidad de La Sabana - Instituto Nacional de Cancerología, Bogotá, Colombia; Daniela Seija-Butnaru, MD, Resident, Pain Management and Palliative Care Department, Hospital Militar Central, Universidad de La Sabana - Instituto Nacional de Cancerología, Bogotá, Colombia; Edmundo Gónima Valero, MD, Anesthesiologist, Fellow in Pain Management and Palliative Care Medicine, Chief of the Pain and Palliative Care Department, Hospital Militar Central, Bogotá, Colombia; Claudia del Pilar Acosta Acosta, MD, Anesthesiologist, Hospital Militar Central, Universidad del Rosario - Fundación Cardioinfantil, Bogotá, Colombia; Sebastian Amaya, MS, 6th Year Medical Student, Anesthesiology and Critical Care Interest Group UEB, Universidad El Bosque Colombian School of Medicine, Bogotá, Colombia
| | - Daniela Seija-Butnaru
- Juan Camilo Sánchez-Flórez, MD, Resident, Pain Management and Palliative Care Department, Hospital Militar Central, Universidad de La Sabana - Instituto Nacional de Cancerología, Bogotá, Colombia; Daniela Seija-Butnaru, MD, Resident, Pain Management and Palliative Care Department, Hospital Militar Central, Universidad de La Sabana - Instituto Nacional de Cancerología, Bogotá, Colombia; Edmundo Gónima Valero, MD, Anesthesiologist, Fellow in Pain Management and Palliative Care Medicine, Chief of the Pain and Palliative Care Department, Hospital Militar Central, Bogotá, Colombia; Claudia del Pilar Acosta Acosta, MD, Anesthesiologist, Hospital Militar Central, Universidad del Rosario - Fundación Cardioinfantil, Bogotá, Colombia; Sebastian Amaya, MS, 6th Year Medical Student, Anesthesiology and Critical Care Interest Group UEB, Universidad El Bosque Colombian School of Medicine, Bogotá, Colombia
| | - Edmundo Gónima Valero
- Juan Camilo Sánchez-Flórez, MD, Resident, Pain Management and Palliative Care Department, Hospital Militar Central, Universidad de La Sabana - Instituto Nacional de Cancerología, Bogotá, Colombia; Daniela Seija-Butnaru, MD, Resident, Pain Management and Palliative Care Department, Hospital Militar Central, Universidad de La Sabana - Instituto Nacional de Cancerología, Bogotá, Colombia; Edmundo Gónima Valero, MD, Anesthesiologist, Fellow in Pain Management and Palliative Care Medicine, Chief of the Pain and Palliative Care Department, Hospital Militar Central, Bogotá, Colombia; Claudia del Pilar Acosta Acosta, MD, Anesthesiologist, Hospital Militar Central, Universidad del Rosario - Fundación Cardioinfantil, Bogotá, Colombia; Sebastian Amaya, MS, 6th Year Medical Student, Anesthesiology and Critical Care Interest Group UEB, Universidad El Bosque Colombian School of Medicine, Bogotá, Colombia
| | - Claudia Del Pilar Acosta Acosta
- Juan Camilo Sánchez-Flórez, MD, Resident, Pain Management and Palliative Care Department, Hospital Militar Central, Universidad de La Sabana - Instituto Nacional de Cancerología, Bogotá, Colombia; Daniela Seija-Butnaru, MD, Resident, Pain Management and Palliative Care Department, Hospital Militar Central, Universidad de La Sabana - Instituto Nacional de Cancerología, Bogotá, Colombia; Edmundo Gónima Valero, MD, Anesthesiologist, Fellow in Pain Management and Palliative Care Medicine, Chief of the Pain and Palliative Care Department, Hospital Militar Central, Bogotá, Colombia; Claudia del Pilar Acosta Acosta, MD, Anesthesiologist, Hospital Militar Central, Universidad del Rosario - Fundación Cardioinfantil, Bogotá, Colombia; Sebastian Amaya, MS, 6th Year Medical Student, Anesthesiology and Critical Care Interest Group UEB, Universidad El Bosque Colombian School of Medicine, Bogotá, Colombia
| | - Sebastian Amaya
- Juan Camilo Sánchez-Flórez, MD, Resident, Pain Management and Palliative Care Department, Hospital Militar Central, Universidad de La Sabana - Instituto Nacional de Cancerología, Bogotá, Colombia; Daniela Seija-Butnaru, MD, Resident, Pain Management and Palliative Care Department, Hospital Militar Central, Universidad de La Sabana - Instituto Nacional de Cancerología, Bogotá, Colombia; Edmundo Gónima Valero, MD, Anesthesiologist, Fellow in Pain Management and Palliative Care Medicine, Chief of the Pain and Palliative Care Department, Hospital Militar Central, Bogotá, Colombia; Claudia del Pilar Acosta Acosta, MD, Anesthesiologist, Hospital Militar Central, Universidad del Rosario - Fundación Cardioinfantil, Bogotá, Colombia; Sebastian Amaya, MS, 6th Year Medical Student, Anesthesiology and Critical Care Interest Group UEB, Universidad El Bosque Colombian School of Medicine, Bogotá, Colombia
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Roudsari PP, Alavi-Moghadam S, Rezaei-Tavirani M, Goodarzi P, Tayanloo-Beik A, Sayahpour FA, Larijani B, Arjmand B. The Outcome of Stem Cell-Based Therapies on the Immune Responses in Rheumatoid Arthritis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1326:159-186. [PMID: 32926346 DOI: 10.1007/5584_2020_581] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Rheumatoid arthritis as a common autoimmune inflammatory disorder with unknown etiology can affect 0.5-1% of adults in developed countries. It involves more than just the patient's joints and can be accompanied by several comorbidities and affect cardiovascular, pulmonary, and some other systems of the human body. Although cytokine-mediated pathways are mentioned to have a central role in RA pathogenesis, adaptive and innate immune systems and intracellular signaling pathways all have important roles in this process. Non-steroidal anti-inflammatory drugs, glucocorticoids, conventional disease-modifying anti-rheumatic drugs, and biological agents are some mentioned medications used for RA. They are accompanied by some adverse effects and treatment failures which elucidates the needing for novel and more powerful therapeutic approaches. Stem cell-based therapies and their beneficial effects on therapeutic processes of different diseases have been founded so far. They can be an alternative and promising therapeutic approach for RA, too; due to their effects on immune responses of the disease. This review, besides some explanations about RA characteristics, addresses the outcome of the stem cell-based therapies including mesenchymal stem cell transplantation and hematopoietic stem cell transplantation for RA and explains their effects on the disease improvement.
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Affiliation(s)
- Peyvand Parhizkar Roudsari
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Alavi-Moghadam
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Parisa Goodarzi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Tayanloo-Beik
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Forough Azam Sayahpour
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical sciences, Tehran, Iran
| | - Babak Arjmand
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. .,Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Mathias K, Amarnani A, Pal N, Karri J, Arkfeld D, Hagedorn JM, Abd-Elsayed A. Chronic Pain in Patients with Rheumatoid Arthritis. Curr Pain Headache Rep 2021; 25:59. [PMID: 34269913 DOI: 10.1007/s11916-021-00973-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Chronic pain is highly prevalent in patients with rheumatoid arthritis (RA) and can cause various physical and psychological impairments. Unfortunately, the appropriate diagnosis of chronic pain syndromes in this population can be challenging because pain may be primary to RA-specific inflammation and/or secondary to other conditions, typically osteoarthritis (OA) and fibromyalgia (FM). This disparity further poses a clinical challenge, given that chronic pain can often be discordant or undetected with standard RA-specific surveillance strategies, including serological markers and imaging studies. In this review, we provide a robust exploration of chronic pain in the RA population with emphasis on epidemiology, mechanisms, and management strategies. RECENT FINDINGS Chronic pain associated with RA typically occurs in patients with anxiety, female sex, and elevated inflammatory status. Up to 50% of these patients are thought to have chronic pain despite appropriate inflammatory suppression, typically due to peripheral and central sensitization as well as secondary OA and FM. In addition to the standard-of-care management for OA and FM, patients with RA and chronic pain benefit from behavioral and psychological treatment options. Moreover, early and multimodal therapies, including non-pharmacological, pharmacological, interventional, and surgical strategies, exist, albeit with varying efficacy, to help suppress inflammation, provide necessary analgesia, and optimize functional outcomes. Overall, chronic pain in RA is a difficult entity for both patients and providers. Early diagnosis, improved understanding of its mechanisms, and initiation of early, targeted approaches to pain control may help to improve outcomes in this population.
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Affiliation(s)
- Kristen Mathias
- Department of Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Abhimanyu Amarnani
- Department of Internal Medicine, Division of Rheumatology, Los Angeles County + University of Southern California (LAC + USC) and Keck Medicine of USC, Los Angeles, CA, USA
| | - Neha Pal
- Texas A&M School of Medicine, Bryan, TX, USA
| | - Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Daniel Arkfeld
- Department of Internal Medicine, Division of Rheumatology, Los Angeles County + University of Southern California (LAC + USC) and Keck Medicine of USC, Los Angeles, CA, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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20
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Yuan G, Yang S, Gautam M, Luo W, Yang S. Macrophage regulator of G-protein signaling 12 contributes to inflammatory pain hypersensitivity. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:448. [PMID: 33850845 PMCID: PMC8039686 DOI: 10.21037/atm-20-5729] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Pain is a predominant symptom in rheumatoid arthritis (RA) patients that results from joint inflammation and is augmented by central sensitization. Regulator of G-protein signaling 12 (RGS12) is the largest protein in the RGS protein family and plays a key role in the development of inflammation. This study investigated the regulation of RGS12 in inflammatory pain and explored the underlying mechanisms and potential RA pain targets. Methods Macrophage-specific RGS12-deficient (LysM-Cre+;RGS12fl/fl) mice were generated by mating RGS12fl/fl mice with LysM-Cre+ transgenic mice. Collagen antibody-induced arthritis (CAIA) models were induced in LysM-Cre+;RGS12fl/fl mice by the administration of a cocktail of five monoclonal antibodies and LPS. Mouse nociception was examined using the von Frey and heat plate tests. Primary macrophages and RAW264.7 cells were used to analyze the regulatory function and mechanism of RGS12 in vitro. The expression and function of RGS12 and COX2 (cyclooxygenase 2) were determined by real-time PCR, ELISA, and luciferase assays. Results Ablation of RGS12 in macrophages decreased pain-related phenotypes, such as paw swelling, the clinical score, and the inflammatory score, in the CAIA model. LysM-Cre+;RGS12fl/fl mice displayed increased resistance to thermal and mechanical stimulation from day 3 to day 9 during CAIA, indicating the inhibition of inflammatory pain. Overexpression of COX2 and PGE2 in macrophages enhanced RGS12 expression, and PGE2 regulated RGS12 expression through the G-protein-coupled receptors EP2 and EP4. Furthermore, RGS12 or the RGS12 PTB domain strengthened the transcriptional regulation of COX2 by NF-κB, whereas inhibiting NF-κB suppressed RGS12-mediated regulation of COX2 in macrophages. Conclusions Our results demonstrate that the deletion of RGS12 in macrophages attenuates inflammatory pain, which is likely due to impaired regulation of the COX2/PGE2 signaling pathway.
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Affiliation(s)
- Gongsheng Yuan
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shuting Yang
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mayank Gautam
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wenqin Luo
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shuying Yang
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Innovation & Precision Dentistry, School of Dental Medicine, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA.,The Penn Center for Musculoskeletal Disorders, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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21
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Pain Mechanism in Rheumatoid Arthritis: From Cytokines to Central Sensitization. Mediators Inflamm 2020; 2020:2076328. [PMID: 33005097 PMCID: PMC7503123 DOI: 10.1155/2020/2076328] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022] Open
Abstract
Pain is the most common symptom in patients with rheumatoid arthritis (RA). Although in recent years, through the implementation of targeted treatment and the introduction of disease-modifying antirheumatic drugs (DMARDs), the treatment of RA patients has made a significant progress, a large proportion of patients still feel pain. Finding appropriate treatment to alleviate the pain is very important for RA patients. Current research showed that, in addition to inflammation, RA pain involves peripheral sensitization and abnormalities in the central nervous system (CNS) pain regulatory mechanisms. This review summarized the literature on pain mechanisms of RA published in recent years. A better understanding of pain mechanisms will help to develop new analgesic targets and deploy new and existing therapies.
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22
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Blom AB, van den Bosch MH, Blaney Davidson EN, Roth J, Vogl T, van de Loo FA, Koenders M, van der Kraan PM, Geven EJ, van Lent PL. The alarmins S100A8 and S100A9 mediate acute pain in experimental synovitis. Arthritis Res Ther 2020; 22:199. [PMID: 32854769 PMCID: PMC7457270 DOI: 10.1186/s13075-020-02295-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/17/2020] [Indexed: 01/15/2023] Open
Abstract
Background Synovitis-associated pain is mediated by inflammatory factors that may include S100A8/9, which is able to stimulate nociceptive neurons via Toll-like receptor 4. In this study, we investigated the role of S100A9 in pain response during acute synovitis. Methods Acute synovitis was induced by streptococcal cell wall (SCW) injection in the knee joint of C57Bl/6 (WT) and S100A9−/− mice. The expression of S100A8/A9 was determined in serum and synovium by ELISA and immunohistochemistry. Inflammation was investigated by 99mTc accumulation, synovial cytokine release, and histology at days 1, 2, and 7. To assess pain, weight distribution, gait analysis, and mechanical allodynia were monitored. Activation markers in afferent neurons were determined by qPCR and immunohistochemistry in the dorsal root ganglia (DRG). Differences between groups were tested using a one-way or two-way analysis of variance (ANOVA). Differences in histology were tested with a non-parametric Mann–Whitney U test. p values lower than 0.05 were considered significant. Results Intra-articular SCW injection resulted in increased synovial expression and serum levels of S100A8/A9 at day 1. These increased levels, however, did not contribute to the development of inflammation, since this was equal in S100A9−/− mice. WT mice showed a significantly decreased percentage of weight bearing on the SCW hind paw on day 1, while S100A9−/− mice showed no reduction. Gait analysis showed increased “limping” behavior in WT, but not S100A9−/− mice. Mechanical allodynia was observed but not different between WT and S100A9−/− when measuring paw withdrawal threshold. The gene expression of neuron activation markers NAV1.7, ATF3, and GAP43 in DRG was significantly increased in arthritic WT mice at day 1 but not in S100A9−/− mice. Conclusions S100A8/9, released from the synovium upon inflammation, is an important mediator of pain response in the knee during the acute phase of inflammation.
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Affiliation(s)
- Arjen B Blom
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands.
| | - Martijn H van den Bosch
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Esmeralda N Blaney Davidson
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Johannes Roth
- Institute of Immunology, University of Münster, Münster, Germany
| | - Thomas Vogl
- Institute of Immunology, University of Münster, Münster, Germany
| | - Fons A van de Loo
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Marije Koenders
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Peter M van der Kraan
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Edwin J Geven
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Peter L van Lent
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
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23
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Vargas-Ruiz R, Montiel-Ruiz RM, Herrera-Ruiz M, González-Cortazar M, Ble-González EA, Jiménez-Aparicio AR, Jiménez-Ferrer E, Zamilpa A. Effect of phenolic compounds from Oenothera rosea on the kaolin-carrageenan induced arthritis model in mice. JOURNAL OF ETHNOPHARMACOLOGY 2020; 253:112711. [PMID: 32097698 DOI: 10.1016/j.jep.2020.112711] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Oenothera rosea (Onagraceae), commonly known as "hierba del golpe" in Mexico, is an herbaceous plant widely used in Mexican traditional medicine for the treatment of pain and inflammation. AIM OF THE STUDY The aim of this study was to assess the effect of extracts and compounds isolated from O. rosea in kaolin-carrageenan induced arthritis. MATERIALS AND METHODS Hydroalcoholic extract from aerial parts of O. rosea was obtained and chemically separated in order to obtain OrEA and isolated compounds using column chromatography, HPLC, UPLC and NMR analysis. O. rosea extract and derivatives were tested on the kaolin/carrageenan (K/C) induced arthritis model on ICR mice. Knee inflammation and paw withdrawal threshold were assessed following intraarticular administration of kaolin and carrageenan (4% and 2%, respectively) and subsequent oral administration of O. rosea. TNF-α, IL-1β, IL-6 and IL-10 levels from synovial capsule were measured using ELISA kits. NF-κB activity was also measured using the RAWBlue™ cell line. Finally, spleen and lungs were dissected to investigate body index. RESULTS Oral administration of the O. rosea ethyl acetate fraction (25, 50 and 100 mg/kg) and isolated compounds (2 mg/kg) reduced the edema induced by kaolin/carrageenan, similar to the effect of methotrexate (1 mg/kg). Hyperalgesia but not allodynia was observed during this experiment. O. rosea derivatives reduced this behavior. The quantification of cytokines showed a reduction in TNF-α, IL-1β and IL-6, as well as an increase of IL-10. NF-κB production was also reduced by administering O. rosea derivatives. Chemical analysis of O. rosea derivatives showed that the major compounds present in the ethyl acetate fraction were phenolic compounds. Gallic acid, quercetin glucoside and quercetin rhamnoside were separated and identified by UPLC-UV-MS, and myricetin glycoside and tamarixetin glucoside using 1H and 13C NMR. CONCLUSIONS O. rosea produces different phenolic compounds capable of reducing the inflammation and secondary mechanical hyperalgesia produced by K/C administration. They also reduced proinflammatory cytokines and increased anti-inflammatory cytokines. Finally, NF-κB modulation was reduced by the administration of O. rosea. Therefore, O. rosea could be considered of interest in inflammatory and painful diseases.
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Affiliation(s)
- Rodrigo Vargas-Ruiz
- Centro de Investigación Biomédica Del Sur (CIBIS), Instituto Mexicano Del Seguro Social (IMSS), Xochitepec, Morelos, Mexico; Centro de Desarrollo de Productos Bióticos (CeProBi), Instituto Politécnico Nacional, Yautepec, Morelos, Mexico
| | - Rosa Mariana Montiel-Ruiz
- Centro de Investigación Biomédica Del Sur (CIBIS), Instituto Mexicano Del Seguro Social (IMSS), Xochitepec, Morelos, Mexico
| | - Maribel Herrera-Ruiz
- Centro de Investigación Biomédica Del Sur (CIBIS), Instituto Mexicano Del Seguro Social (IMSS), Xochitepec, Morelos, Mexico
| | - Manasés González-Cortazar
- Centro de Investigación Biomédica Del Sur (CIBIS), Instituto Mexicano Del Seguro Social (IMSS), Xochitepec, Morelos, Mexico
| | - Ever A Ble-González
- División Académica de Ciencias Básicas, Universidad Juárez Autónoma de Tabasco, Carretera Cunduacán-Jalpa Km. 0.5, Cunduacán, Tabasco, 86690, Mexico
| | | | - Enrique Jiménez-Ferrer
- Centro de Investigación Biomédica Del Sur (CIBIS), Instituto Mexicano Del Seguro Social (IMSS), Xochitepec, Morelos, Mexico
| | - Alejandro Zamilpa
- Centro de Investigación Biomédica Del Sur (CIBIS), Instituto Mexicano Del Seguro Social (IMSS), Xochitepec, Morelos, Mexico.
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24
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Heidari B, Hajian-Tilaki K, Babaei M. Vitamin D Deficiency and Rheumatoid Arthritis: Epidemiological, Immunological, Clinical and Therapeutic Aspects. Mediterr J Rheumatol 2020; 30:94-102. [PMID: 32185348 PMCID: PMC7045965 DOI: 10.31138/mjr.30.2.94] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/08/2019] [Accepted: 04/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background/Aim: Vitamin D displays an immunologic effect which can modulate function of Th17-related cytokines and thereby prevent perpetuation of inflammation in chronic disorders like rheumatoid arthritis (RA). This review aims to conduct a literature review to provide a summary of recent studies addressing the relationship between vitamin D deficiency and RA based on epidemiological, immunological and therapeutic aspects. Methods: PubMed, Scopus and Google scholar were searched for relevant papers published between 2000–2018. Results: Low intake of vitamin D increases the risk of incident RA, and vitamin D deficiency has been shown to be inversely associated with RA activity in most of these studies. However, characteristics of RA and serum vitamin D status differ across the studies. The results of studies on the effect of supplemental vitamin D in RA vary, from no efficacy to significant improvement in disease activity, as well as quality of life. This should be attributed to variations in dosage of vitamin D, duration of treatment, baseline serum vitamin D in RA patients and characteristics of RA across diverse studies. Conclusion: Current data indicate a therapeutic potential for vitamin D in RA. However, further studies are needed to identify an optimal and effective dosage, duration of treatment and patients who will get the best benefit from the treatment.
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Affiliation(s)
- Behzad Heidari
- Mobility Impairment Research Center; Babol University of Medical Sciences, Babol, Islamic Republic of Iran.,Clinical Research Development Unit of Rouhani Hospital; Babol University of Medical Sciences, Babol, Islamic Republic of Iran.,Department of Internal Medicine, Division of Rheumatology; Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Karimollah Hajian-Tilaki
- Department of Statistics and Epidemiology, School of Medicine; Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Mansour Babaei
- Mobility Impairment Research Center; Babol University of Medical Sciences, Babol, Islamic Republic of Iran.,Clinical Research Development Unit of Rouhani Hospital; Babol University of Medical Sciences, Babol, Islamic Republic of Iran.,Department of Internal Medicine, Division of Rheumatology; Babol University of Medical Sciences, Babol, Islamic Republic of Iran
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25
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Ioussoufovitch S, Morrison LB, Desjardins L, Hadway JA, Lawrence KS, Lee TY, Beier F, Diop M. Quantification of joint blood flow by dynamic contrast-enhanced near-infrared spectroscopy: application to monitoring disease activity in a rat model of rheumatoid arthritis. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:1-10. [PMID: 31939225 PMCID: PMC6983648 DOI: 10.1117/1.jbo.25.1.015003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/06/2019] [Indexed: 05/11/2023]
Abstract
Significance Current guidelines for rheumatoid arthritis (RA) management recommend early treatment with disease modifying antirheumatic drugs (DMARDs). However, DMARD treatment fails in 30% of patients and current monitoring methods can only detect failure after 3 to 6 months of therapy. Aim We investigated whether joint blood flow (BF), quantified using dynamic contrast-enhanced time-resolved near-infrared spectroscopy, can monitor disease activity and treatment response in a rat model of RA. Approach Ankle joint BF was measured every 5 days in eight rats with adjuvant-induced arthritis (AIA) and four healthy controls. Arthritis was allowed to progress for 20 days before rats with AIA were treated with a DMARD once every 5 days until day 40. Results Time and group had separate significant main effects on joint BF; however, there was no significant interaction between time and group despite a notable difference in average joint BF on day 5. Comparison of individual blood flow measures between rats with AIA and control group animals did not reveal a clear response to treatment. Conclusions Joint BF time courses could not distinguish between rats with AIA and study controls. Heterogeneous disease response and low temporal frequency of BF measurements may have been important study limitations.
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Affiliation(s)
- Seva Ioussoufovitch
- Western University, Bone and Joint Institute, School of Biomedical Engineering, Faculty of Engineering, London, Ontario, Canada
| | - Laura B. Morrison
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
| | - Lise Desjardins
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
| | - Jennifer A. Hadway
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
| | - Keith St. Lawrence
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Schulich School of Medicine and Dentistry, Department of Medical Biophysics, London, Ontario, Canada
| | - Ting-Yim Lee
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Schulich School of Medicine and Dentistry, Department of Medical Biophysics, London, Ontario, Canada
- Robarts Research Institute, Imaging Program, London, Ontario, Canada
| | - Frank Beier
- Western University, Schulich School of Medicine and Dentistry, Department of Physiology and Pharmacology, London, Ontario, Canada
| | - Mamadou Diop
- Western University, Bone and Joint Institute, School of Biomedical Engineering, Faculty of Engineering, London, Ontario, Canada
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Schulich School of Medicine and Dentistry, Department of Medical Biophysics, London, Ontario, Canada
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26
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Lee YC, Fine A, Protsenko E, Massarotti E, Edwards RR, Mawla I, Napadow V, Loggia ML. Brain Correlates of Continuous Pain in Rheumatoid Arthritis as Measured by Pulsed Arterial Spin Labeling. Arthritis Care Res (Hoboken) 2019; 71:308-318. [PMID: 29781581 DOI: 10.1002/acr.23601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 05/15/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Central nervous system pathways involving pain modulation shape the pain experience in patients with chronic pain. The aims of this study were to understand the mechanisms underlying pain in patients with rheumatoid arthritis (RA) and to identify brain signals that may serve as imaging markers for developing targeted treatments for RA-related pain. METHODS Patients with RA and matched control subjects underwent functional magnetic resonance imaging, using pulsed arterial spin labeling. The imaging conditions included 1) resting state, 2) low-intensity stimulus, and 3) high-intensity stimulus. Stimuli consisted of mechanical pressure applied to metacarpophalangeal (MCP) joints with an automated cuff inflator. The low-intensity stimulus was inflation to 30 mm Hg. The high-intensity stimulus was the amount of pressure required to achieve a pain intensity rating of 40 on a 100-point scale for each RA patient, with the same amount of pressure used in the matched control. RESULTS Among RA patients, regional cerebral blood flow (rCBF) in the medial frontal cortex and dorsolateral prefrontal cortex increased during both low-pressure and high-pressure stimulation. No rCBF changes were observed in pain-free controls. Region-of-interest analyses in RA patients showed that baseline rCBF in the medial frontal cortex was negatively correlated with the pressure required for the high-intensity stimulus and positively correlated with pain induced by the low-intensity stimulus. Baseline rCBF was also marginally correlated with disease activity). Regional CBF during high pain was positively correlated with pain severity and pain interference. CONCLUSION In response to clinically relevant joint pain evoked by pressure applied to the MCP joint, neural processing in the medial frontal cortex increases and is directly associated with clinical pain in patients with RA.
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Affiliation(s)
- Yvonne C Lee
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alexander Fine
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ekaterina Protsenko
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elena Massarotti
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert R Edwards
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ishtiaq Mawla
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vitaly Napadow
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marco L Loggia
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Carpenter L, Barnett R, Mahendran P, Nikiphorou E, Gwinnutt J, Verstappen S, Scott DL, Norton S. Secular changes in functional disability, pain, fatigue and mental well-being in early rheumatoid arthritis. A longitudinal meta-analysis. Semin Arthritis Rheum 2019; 50:209-219. [PMID: 31521376 DOI: 10.1016/j.semarthrit.2019.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/09/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To conduct a systematic review and longitudinal meta-analysis of early rheumatoid arthritis (RA) cohorts with long-term data on pain, fatigue or mental well-being. METHODS Searches using PUBMED, EMBASE and PyscInfo were performed to identify all early RA cohorts with longitudinal measures of pain, fatigue or mental well-being, along with clinical measures. Using longitudinal meta-analyses, the progression of each outcome over the first 60-months was estimated. Cohorts were stratified based on the median recruitment year to investigate secular trends in disease progression. RESULTS Of 7,319 papers identified, 75 met the inclusion criteria and 46 cohorts from 41 publications provided sufficient data on 18,046 patients for meta-analysis. The Disease Activity Scores (DAS28) and the Short-Form 36 (SF-36) Physical Component Score (PCS) indicated that post-2002 cohorts had statistically significant improvements over the first 60-months compared to pre-2002 cohorts, with standardised mean differences (SMD) of 0.86 (95% Confidence Intervals 0.34 to 1.37) and 0.76 (95% CI 0.25 to 1.27) respectively at month-60. However, post-2002 cohorts indicated statistically non-significant improvements in pain, fatigue, functional disability and SF-36 Mental Component Score (MCS) compared to pre-2002 cohorts, with SMD of 0.24 (95% CI -0.25 to 0.74), 0.38 (95% CI -0.11 to 0.88), 0.34 (95% CI -0.15-0.84) and -0.08 (95% CI -0.41 to 0.58) at month-60 respectively. CONCLUSIONS Recent cohorts indicate improved levels of disease activity and physical quality of life, however this has not translated into similar improvements in levels of pain, fatigue and functional disability by 60-months.
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Affiliation(s)
- L Carpenter
- Health Psychology Section, King's College London, London, United Kingdom.
| | - R Barnett
- Health Psychology Section, King's College London, London, United Kingdom
| | - P Mahendran
- Health Psychology Section, King's College London, London, United Kingdom
| | - E Nikiphorou
- Department of Inflammation Biology, King's College London, London, United Kingdom
| | - J Gwinnutt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - S Verstappen
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - D L Scott
- Department of Inflammation Biology, King's College London, London, United Kingdom
| | - S Norton
- Health Psychology Section, King's College London, London, United Kingdom; Department of Inflammation Biology, King's College London, London, United Kingdom
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28
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Stahnke K, Morawietz L, Moroder P, Scheibel M. Synovitis as a concomitant disease in shoulder pathologies. Arch Orthop Trauma Surg 2019; 139:1111-1116. [PMID: 30820695 DOI: 10.1007/s00402-019-03152-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Shoulder pathologies are often accompanied by rotator interval synovitis. This phenomenon is poorly described in the literature so far. The aim of the study was to analyze the occurrence of macroscopically visible synovial reaction in the rotator interval in patients with chronic shoulder pathologies and to perform a histopathological evaluation. MATERIALS AND METHODS In this prospective cohort study, 167 consecutive patients undergoing arthroscopic shoulder surgery for chronic shoulder pathology were included (♀ = 45, ♂ = 122; [Formula: see text]54.5 years ± 12.8). Included patients were divided into subgroups according to the encountered chronic shoulder pathology: (1) impingement syndrome with or without bursal sided partial rotator cuff tear (RCT); (2) articular sided partial RCT; (3) full-thickness RCT; (4) RCT that involves at least two tendons; (5) shoulder instability; and (6) cartilage damage. Standardized soft tissue biopsies from the rotator interval were taken. The synovitis score of Krenn/Morawietz was used for histopathological examination. RESULTS Extraarticular pathology (group 1) showed significantly decreased synovitis scores compared to all the other groups. Increased size of rotator cuff tears (group 4), as well as cartilage damage (group 6) showed significantly higher synovitis scores than group 3 (p < 0.05). Moreover, the synovitis score was significantly increased in patients with concomitant pathologies of the long head of the biceps (p = 0.001). CONCLUSIONS This study suggests that chronic intra- and extraarticular shoulder diseases are very often accompanied by a histopathologically verifiable low-grade synovitis. Intraarticular pathologies seem to induce increased levels of synovitis. Furthermore, the increased size of rotator cuff tears is accompanied by a higher degree of synovitis. STUDY DESIGN Cohort study, level of evidence, 2b.
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Affiliation(s)
- Katharina Stahnke
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Lars Morawietz
- Pathology, MVZ Fuerstenberg-Karree Berlin, 14199, Berlin, Germany
| | - Philipp Moroder
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Schulthess Clinic, Zurich, Switzerland.
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Opioid use in rheumatoid arthritis: trends, efficacy, safety, and best practices. Curr Opin Rheumatol 2019; 31:264-270. [DOI: 10.1097/bor.0000000000000602] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Li Y, Kakkar R, Wang J. In vivo and in vitro Approach to Anti-arthritic and Anti-inflammatory Effect of Crocetin by Alteration of Nuclear Factor-E2-Related Factor 2/hem Oxygenase (HO)-1 and NF-κB Expression. Front Pharmacol 2018; 9:1341. [PMID: 30618728 PMCID: PMC6299880 DOI: 10.3389/fphar.2018.01341] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 10/31/2018] [Indexed: 01/15/2023] Open
Abstract
Crocetin (apo carotenoid dicarboxylic acid) is a common constituent of saffron. Its importance is well documented in Chinese medicine. Some studies have reported the inhibitory effect on inflammation in rats. The aim of the current experimental investigation to scrutinize the anti-inflammatory effect of Crocetin using the lipo polysaccharide (LPS) induced mouse macrophages (RAW 264.7) in vitro and complete Freund’s adjuvant-induced arthritis model and to explore in vivo possible mechanism of action. RAW 264.7 macrophages were used for estimation of the effect of crocetin on the cyclooxygenase (COX-2), nitric oxide (NO)production, anti-inflammatory and along with pro-inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), and interleukin-10 (IL-10). Single intraperitoneal injection of complete freund’s adjuvant (CFA) was used to induce arthritis. The rats were divided into different group and received the oral administration of crocetin in a dose-dependent manner with indomethacin till 28 days. The paw edema and body weight was estimated at regular interval of time. The biochemical parameters, hematological and pro-inflammatory cytokines such as tumor necrosis factor receptor 1 (TNF-R1), IL-6, and IL-1β, Vascular endothelial growth factor (VEGF); heme oxygenase-1/nuclear factor erythroid 2–related factor 2 (HO-1/Nrf-2) expression were estimated at end of the experimental study. Crocetin inhibited the COX-2 catalyzed prostaglandin (PGE2) and inducible nitric oxide synthase catalyzed NO production on RAW 264.7. The paw edema and body weight was significantly (P < 0.001) modulated by the Crocetin in a dose-dependent manner. Crocetin treatment increased the level of red blood cells (RBC), hemoglobin (Hb) and decreased level of white blood cells (WBC), erythrocyte sedimentation rate (ESR), alkaline phosphatase (ALP), serum glutamic pyruvic transaminase (SGPT), and serum glutamic-oxaloacetic transaminase (SGOT) parameters, with reduction of TNF-α, IL-6, and IL-1β.The protective effect of crocetin was substantiated with a reduction in expression of IL-6, IL-1β, VEGF, and TNF-R1, respectively. Crocetin also increased the HO-1/Nrf-2 and decreased the nuclear factor kappa-B (NF-κB) mRNA, protein expression. On the basis of the result, we can conclude that the reduction of HO-1/Nrf-2 expression, as well as inflammatory mediators, may be involved in the protective effect of Crocetin in the CFA model.
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Affiliation(s)
- Yi Li
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Rajat Kakkar
- Chandrasheker College of Pharmacy, Allahabad, India
| | - Jian Wang
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Beazley-Long N, Moss CE, Ashby WR, Bestall SM, Almahasneh F, Durrant AM, Benest AV, Blackley Z, Ballmer-Hofer K, Hirashima M, Hulse RP, Bates DO, Donaldson LF. VEGFR2 promotes central endothelial activation and the spread of pain in inflammatory arthritis. Brain Behav Immun 2018; 74:49-67. [PMID: 29548992 PMCID: PMC6302073 DOI: 10.1016/j.bbi.2018.03.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/02/2018] [Accepted: 03/11/2018] [Indexed: 02/01/2023] Open
Abstract
Chronic pain can develop in response to conditions such as inflammatory arthritis. The central mechanisms underlying the development and maintenance of chronic pain in humans are not well elucidated although there is evidence for a role of microglia and astrocytes. However in pre-clinical models of pain, including models of inflammatory arthritis, there is a wealth of evidence indicating roles for pathological glial reactivity within the CNS. In the spinal dorsal horn of rats with painful inflammatory arthritis we found both a significant increase in CD11b+ microglia-like cells and GFAP+ astrocytes associated with blood vessels, and the number of activated blood vessels expressing the adhesion molecule ICAM-1, indicating potential glio-vascular activation. Using pharmacological interventions targeting VEGFR2 in arthritic rats, to inhibit endothelial cell activation, the number of dorsal horn ICAM-1+ blood vessels, CD11b+ microglia and the development of secondary mechanical allodynia, an indicator of central sensitization, were all prevented. Targeting endothelial VEGFR2 by inducible Tie2-specific VEGFR2 knock-out also prevented secondary allodynia in mice and glio-vascular activation in the dorsal horn in response to inflammatory arthritis. Inhibition of VEGFR2 in vitro significantly blocked ICAM-1-dependent monocyte adhesion to brain microvascular endothelial cells, when stimulated with inflammatory mediators TNF-α and VEGF-A165a. Taken together our findings suggest that a novel VEGFR2-mediated spinal cord glio-vascular mechanism may promote peripheral CD11b+ circulating cell transmigration into the CNS parenchyma and contribute to the development of chronic pain in inflammatory arthritis. We hypothesise that preventing this glio-vascular activation and circulating cell translocation into the spinal cord could be a new therapeutic strategy for pain caused by rheumatoid arthritis.
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Affiliation(s)
- Nicholas Beazley-Long
- Arthritis Research UK Pain Centre & School of Life Sciences, Medical School, University of Nottingham, Nottingham NG7 2UH, UK.
| | - Catherine Elizabeth Moss
- Arthritis Research UK Pain Centre & School of Life Sciences, Medical School, University of Nottingham, Nottingham NG7 2UH, UK
| | - William Robert Ashby
- Arthritis Research UK Pain Centre & School of Life Sciences, Medical School, University of Nottingham, Nottingham NG7 2UH, UK
| | - Samuel Marcus Bestall
- Cancer Biology, School of Medicine, QMC, University of Nottingham, Nottingham NG7 2UH, UK
| | - Fatimah Almahasneh
- Arthritis Research UK Pain Centre & School of Life Sciences, Medical School, University of Nottingham, Nottingham NG7 2UH, UK
| | - Alexandra Margaret Durrant
- Arthritis Research UK Pain Centre & School of Life Sciences, Medical School, University of Nottingham, Nottingham NG7 2UH, UK
| | - Andrew Vaughan Benest
- Cancer Biology, School of Medicine, QMC, University of Nottingham, Nottingham NG7 2UH, UK
| | - Zoe Blackley
- Cancer Biology, School of Medicine, QMC, University of Nottingham, Nottingham NG7 2UH, UK
| | | | - Masanori Hirashima
- Department of Physiology and Cell Biology, Kobe University Graduate School of Medicine, Japan
| | - Richard Phillip Hulse
- Cancer Biology, School of Medicine, QMC, University of Nottingham, Nottingham NG7 2UH, UK
| | - David Owen Bates
- Cancer Biology, School of Medicine, QMC, University of Nottingham, Nottingham NG7 2UH, UK,COMPARE University of Birmingham and University of Nottingham Midlands, UK
| | - Lucy Frances Donaldson
- Arthritis Research UK Pain Centre & School of Life Sciences, Medical School, University of Nottingham, Nottingham NG7 2UH, UK
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Zhou LL, Zhu YM, Qian FY, Yuan CC, Yuan DP, Zhou XP. MicroRNA‑143‑3p contributes to the regulation of pain responses in collagen‑induced arthritis. Mol Med Rep 2018; 18:3219-3228. [PMID: 30066874 PMCID: PMC6102648 DOI: 10.3892/mmr.2018.9322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/26/2018] [Indexed: 12/16/2022] Open
Abstract
Patients with rheumatoid arthritis (RA) suffer from pain, which is associated with inflammation, peripheral and central pain processing, and joint structure damage. The aim of the present study was to investigate a key microRNA (miR) and its target genes that are involved in the pain responses of RA, and to clarify the mechanism of pain regulation. Collagen‑induced arthritis (CIA) was induced in DBA/1 and C57BL/6 mice. The paw swelling, mechanical withdrawal threshold (MWT), thermal withdrawal latency (TWL), and expression levels of tumor necrosis factor (TNF)‑α and prostaglandin (PG)E2 in the sera were investigated. Decreased MWT and TWL, and increased TNF‑α and PGE2, in the CIA model group were observed in DBA/1 and C57BL/6 mice. DBA/1 mice exhibited greater hyperalgesia and higher levels of inflammatory mediators. miR‑143‑3p expression in the blood and the dorsal root ganglion (DRG) were detected, and low miR‑143‑3p expression was demonstrated in the blood and DRG tissue of CIA mice. The target genes of miR‑143 were predicted and analyzed. A total of 1,305 genes were predicted and 55 pain‑associated genes were obtained. Prostaglandin‑endoperoxide synthase 2 (Ptgs2), MAS related GPR family member E (Mrgpre), prostaglandin D2 receptor and Tnf were selected as target genes of miR‑143. DRG cells were cultured and transfected with miR‑143‑3p inhibitor or mimic. The expression of Mrgpre, Ptgs2 and Tnf was significantly inhibited following miR‑143‑3p mimic transfection, while the expression of Mrgpre, Ptgs2 and Tnf was increased following inhibitor transfection. Additionally, the expression of pain‑associated genes in the DRG of mice was investigated and the expression of Ptgs2, Mrgpre and Tnf in the DRG of CIA mice was also significantly upregulated. These results revealed that CIA mice exhibited marked hyperalgesia and high levels of inflammatory pain mediators. Low expression of miR‑143‑3p negatively regulated the pain‑associated target genes, including Mrgpre, Ptgs2 and Tnf, thereby affecting chronic inflammatory pain and neuropathic pain in RA.
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Affiliation(s)
- Ling-Ling Zhou
- School of Pharmacy, The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Ya-Mei Zhu
- School of Pharmacy, The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Fei-Ya Qian
- School of Pharmacy, The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Cheng-Chen Yuan
- School of Pharmacy, The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Dong-Ping Yuan
- School of Pharmacy, The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Xue-Ping Zhou
- School of Pharmacy, The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
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Cook AD, Christensen AD, Tewari D, McMahon SB, Hamilton JA. Immune Cytokines and Their Receptors in Inflammatory Pain. Trends Immunol 2018; 39:240-255. [DOI: 10.1016/j.it.2017.12.003] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/28/2017] [Accepted: 12/13/2017] [Indexed: 01/23/2023]
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Salaffi F, Giacobazzi G, Di Carlo M. Chronic Pain in Inflammatory Arthritis: Mechanisms, Metrology, and Emerging Targets-A Focus on the JAK-STAT Pathway. Pain Res Manag 2018; 2018:8564215. [PMID: 29623147 PMCID: PMC5829432 DOI: 10.1155/2018/8564215] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/13/2017] [Indexed: 12/14/2022]
Abstract
Chronic pain is nowadays considered not only the mainstay symptom of rheumatic diseases but also "a disease itself." Pain is a multidimensional phenomenon, and in inflammatory arthritis, it derives from multiple mechanisms, involving both synovitis (release of a great number of cytokines) and peripheral and central pain-processing mechanisms (sensitization). In the last years, the JAK-STAT pathway has been recognized as a pivotal component both in the inflammatory process and in pain amplification in the central nervous system. This paper provides a summary on pain in inflammatory arthritis, from pathogenesis to clinimetric instruments and treatment, with a focus on the JAK-STAT pathway.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Department, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | | | - Marco Di Carlo
- Rheumatology Department, Università Politecnica delle Marche, Jesi, Ancona, Italy
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35
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Yesil H, Sungur U, Akdeniz S, Gurer G, Yalcın B, Dundar U. Association between serum vitamin D levels and neuropathic pain in rheumatoid arthritis patients: A cross-sectional study. Int J Rheum Dis 2017; 21:431-439. [PMID: 28857474 DOI: 10.1111/1756-185x.13160] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM Recent literature suggests that neuropathic pain (NP) and vitamin D deficiency can occur concurrently in patients with rheumatoid arthritis (RA). This study aimed to examine the development of NP in patients with RA and the relationship between NP and vitamin D. METHODS We used the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire to evaluate NP in 93 patients with RA. Demographic and clinical data were obtained from patient files and interviews, and patients' serum vitamin D levels were recorded. Patients were requested to complete both the Short Form-36 survey and the Health Assessment Questionnaire. RESULTS Seventy-five of the eligible patients were female (80.6%), and 31 (33.3%) were diagnosed with NP according to the LANSS. There was a negative correlation between vitamin D levels and the LANSS score (P = 0.001). The prevalence of NP was 5.8 times higher among patients with serum vitamin D levels below 20 ng/mL than in patients with vitamin D levels ≥ 30 ng/mL. Based on the area under curve (AUC) values, we found that serum levels of vitamin D were a good predictor of NP diagnoses in patients with RA (AUC = 0.71). CONCLUSION We found that vitamin D deficiency was asssociated with increased NP in patients with RA. Although further research is needed to clarify the association between serum vitamin D levels and NP, our study raises awareness of the need to screen for vitamin D deficiency in RA patients with NP.
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Affiliation(s)
- Hilal Yesil
- Department of Physical Medicine and Rehabilitation, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
| | - Ulas Sungur
- Department of Physical Medicine and Rehabilitation, Ege University Faculty of Medicine, Izmir, Turkey
| | - Sedef Akdeniz
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Adnan Menderes University Faculty of Medicine, Aydin, Turkey
| | - Gulcan Gurer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Adnan Menderes University Faculty of Medicine, Aydin, Turkey
| | - Basak Yalcın
- Department of Physical Medicine and Rehabilitation, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
| | - Umit Dundar
- Department of Physical Medicine and Rehabilitation, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
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Abstract
Osteoarthritis (OA), the most common form of arthritis, causes pain and disability, as well as emotional distress. While total joint replacement is one of the most effective treatments available for improving the quality of life in people with severe OA, it is not suitable for all patients and all joints. Current pharmacological analgesics have limited efficacy, and their use is often restricted by adverse events. Medications that might reduce pain by slowing or preventing structural disease remain elusive. Our increasing understanding of the complex mechanisms that underlie OA pain offers a wide range of potential new treatment targets. New drugs for OA pain might come from repurposing those developed for other conditions, as well as novel compounds targeting pain mechanisms specific to the joint. Here we discuss the mechanisms of OA pain and its therapeutic implications. We explore evolving treatment modalities, including combination treatment. We review recent research and patents pointing to future OA therapies. We discuss the potential for biomarkers to facilitate drug development and targeting.
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Affiliation(s)
- David A Walsh
- 1 Arthritis Research UK Pain Centre, University of Nottingham, UK.,2 Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK.,3 NIHR Nottingham BRC, UK.,4 Sherwood Forest Hospitals NHS Foundation Trust, UK.,5 Nottingham University Hospitals NHS Trust, UK
| | - Joanne Stocks
- 1 Arthritis Research UK Pain Centre, University of Nottingham, UK.,2 Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK.,3 NIHR Nottingham BRC, UK
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37
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Jobski K, Luque Ramos A, Albrecht K, Hoffmann F. Pain, depressive symptoms and medication in German patients with rheumatoid arthritis-results from the linking patient-reported outcomes with claims data for health services research in rheumatology (PROCLAIR) study. Pharmacoepidemiol Drug Saf 2017; 26:766-774. [DOI: 10.1002/pds.4202] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/12/2017] [Accepted: 03/05/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Kathrin Jobski
- Department of Health Services Research; Carl von Ossietzky University Oldenburg; Oldenburg Germany
| | - Andres Luque Ramos
- Department of Health Services Research; Carl von Ossietzky University Oldenburg; Oldenburg Germany
| | - Katinka Albrecht
- Epidemiology Unit; German Rheumatism Research Centre; Berlin Germany
| | - Falk Hoffmann
- Department of Health Services Research; Carl von Ossietzky University Oldenburg; Oldenburg Germany
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38
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Senftleber NK, Nielsen SM, Andersen JR, Bliddal H, Tarp S, Lauritzen L, Furst DE, Suarez-Almazor ME, Lyddiatt A, Christensen R. Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients 2017; 9:E42. [PMID: 28067815 PMCID: PMC5295086 DOI: 10.3390/nu9010042] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/09/2016] [Accepted: 12/21/2016] [Indexed: 12/28/2022] Open
Abstract
Arthritis patients often take fish oil supplements to alleviate symptoms, but limited evidence exists regarding their efficacy. The objective was to evaluate whether marine oil supplements reduce pain and/or improve other clinical outcomes in patients with arthritis. Six databases were searched systematically (24 February 2015). We included randomized trials of oral supplements of all marine oils compared with a control in arthritis patients. The internal validity was assessed using the Cochrane Risk of Bias tool and heterogeneity was explored using restricted maximum of likelihood (REML)-based meta-regression analysis. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the overall quality of the evidence. Forty-two trials were included; 30 trials reported complete data on pain. The standardized mean difference (SMD) suggested a favorable effect (-0.24; 95% confidence interval, CI, -0.42 to -0.07; heterogeneity, I² = 63%. A significant effect was found in patients with rheumatoid arthritis (22 trials; -0.21; 95% CI, -0.42 to -0.004) and other or mixed diagnoses (3 trials; -0.63; 95% CI, -1.20 to -0.06), but not in osteoarthritis patients (5 trials; -0.17; 95% CI, -0.57-0.24). The evidence for using marine oil to alleviate pain in arthritis patients was overall of low quality, but of moderate quality in rheumatoid arthritis patients.
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Affiliation(s)
- Ninna K Senftleber
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen F, Denmark.
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 FC Copenhagen, Denmark.
| | - Sabrina M Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen F, Denmark.
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 FC Copenhagen, Denmark.
| | - Jens R Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 FC Copenhagen, Denmark.
| | - Henning Bliddal
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen F, Denmark.
| | - Simon Tarp
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen F, Denmark.
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 FC Copenhagen, Denmark.
| | - Daniel E Furst
- Division of Rheumatology, University of California, Los Angeles, CA 90095, USA.
| | | | - Anne Lyddiatt
- Musculoskeletal Group, Cochrane Collaboration, Ottawa, ON K1H 8L6, Canada.
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen F, Denmark.
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Rajaram A, Ioussoufovitch S, Morrison LB, St Lawrence K, Lee TY, Bureau Y, Diop M. Joint blood flow is more sensitive to inflammatory arthritis than oxyhemoglobin, deoxyhemoglobin, and oxygen saturation. BIOMEDICAL OPTICS EXPRESS 2016; 7:3843-3854. [PMID: 27867697 PMCID: PMC5102556 DOI: 10.1364/boe.7.003843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/23/2016] [Accepted: 08/28/2016] [Indexed: 05/11/2023]
Abstract
Joint hypoxia plays a central role in the progression and perpetuation of rheumatoid arthritis (RA). Thus, optical techniques that can measure surrogate markers of hypoxia such as blood flow, oxyhemoglobin, deoxyhemoglobin, and oxygen saturation are being developed to monitor RA. The purpose of the current study was to compare the sensitivity of these physiological parameters to arthritis. Experiments were conducted in a rabbit model of RA and the results revealed that joint blood flow was the most sensitive to arthritis and could detect a statistically significant difference (p<0.05, power = 0.8) between inflamed and healthy joints with a sample size of only four subjects. Considering that this a quantitative technique, the high sensitivity to arthritis suggests that joint perfusion has the potential to become a potent tool for monitoring disease progression and treatment response in RA.
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Affiliation(s)
- Ajay Rajaram
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Seva Ioussoufovitch
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Laura B. Morrison
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Keith St Lawrence
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Ting-Yim Lee
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
- Imaging Program, Robarts Research Institute, 100 Perth Drive, London, Ontario N6A 5K8, Canada
| | - Yves Bureau
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
| | - Mamadou Diop
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
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40
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Druce KL, Jones GT, Macfarlane GJ, Basu N. Examining Changes in Central and Peripheral Pain as Mediates of Fatigue Improvement: Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016; 68:922-6. [DOI: 10.1002/acr.22803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/06/2015] [Accepted: 11/17/2015] [Indexed: 01/01/2023]
Affiliation(s)
| | | | | | - Neil Basu
- University of Aberdeen; Aberdeen Scotland
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41
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Walsh DA. Editorial: Synovitis and Pain Sensitization. Arthritis Rheumatol 2016; 68:561-2. [DOI: 10.1002/art.39487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/22/2015] [Indexed: 12/26/2022]
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42
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Lee YC, Massarotti E, Edwards RR, Lu B, Liu C, Lo Y, Wohlfahrt A, Kim ND, Clauw DJ, Solomon DH. Effect of Milnacipran on Pain in Patients with Rheumatoid Arthritis with Widespread Pain: A Randomized Blinded Crossover Trial. J Rheumatol 2015; 43:38-45. [PMID: 26628607 DOI: 10.3899/jrheum.150550] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Clinical trials have shown that serotonin norepinephrine reuptake inhibitors, such as milnacipran, decrease pain in noninflammatory pain conditions such as fibromyalgia and osteoarthritis. We examined the effect of milnacipran on self-reported pain intensity and experimental pain sensitivity among patients with rheumatoid arthritis (RA) with widespread pain and stable RA disease activity. METHODS In this double-blind, crossover study, patients with RA with widespread pain, receiving a stable treatment regimen, were randomized (by a random number generator) to receive milnacipran 50 mg twice daily or placebo for 6 weeks, followed by a 3-week washout and crossed over to the other arm for the remaining 6 weeks. The primary outcome was change in average pain intensity, assessed by the Brief Pain Inventory short form. The sample size was calculated to detect a 30% improvement in pain with power = 0.80 and α = 0.05. RESULTS Of the 43 randomized subjects, 41 received the study drug, and 32 completed the 15-week study per protocol. On a 0-10 scale, average pain intensity decreased by 0.39 (95% CI -1.27 to 0.49, p = 0.37) more points during 6 weeks of milnacipran treatment compared with placebo. In the subgroup of subjects with swollen joint count ≤ 1, average pain intensity decreased by 1.14 more points during 6 weeks of milnacipran compared with placebo (95% CI -2.26 to -0.01, p = 0.04). Common adverse events included nausea (26.8%) and loss of appetite (9.7%). CONCLUSION Compared with placebo, milnacipran did not improve overall, self-reported pain intensity among subjects with widespread pain receiving stable RA medications. TRIAL REGISTRATION ClinicalTrials.gov NCT01207453.
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Affiliation(s)
- Yvonne C Lee
- From the Division of Rheumatology, Immunology and Allergy, and Department of Anesthesiology, Brigham and Women's Hospital; Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Y.C. Lee, MD, MMSc, Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital; E. Massarotti, MD, Division of Rheumatology, Brigham and Women's Hospital; R.R. Edwards, PhD, Pain Management Center, Brigham and Women's Hospital; B. Lu, MD, DrPH, Division of Rheumatology, Brigham and Women's Hospital; C. Liu, PhD, Division of Rheumatology, Brigham and Women's Hospital; Y. Lo, MPH, Division of Rheumatology, Brigham and Women's Hospital; A. Wohlfahrt, BA, Division of Rheumatology, Brigham and Women's Hospital; N.D. Kim, MD, Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital; D.J. Clauw, MD, University of Michigan; D.H. Solomon, MD, MPH, Division of Rheumatology, Brigham and Women's Hospital.
| | - Elena Massarotti
- From the Division of Rheumatology, Immunology and Allergy, and Department of Anesthesiology, Brigham and Women's Hospital; Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Y.C. Lee, MD, MMSc, Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital; E. Massarotti, MD, Division of Rheumatology, Brigham and Women's Hospital; R.R. Edwards, PhD, Pain Management Center, Brigham and Women's Hospital; B. Lu, MD, DrPH, Division of Rheumatology, Brigham and Women's Hospital; C. Liu, PhD, Division of Rheumatology, Brigham and Women's Hospital; Y. Lo, MPH, Division of Rheumatology, Brigham and Women's Hospital; A. Wohlfahrt, BA, Division of Rheumatology, Brigham and Women's Hospital; N.D. Kim, MD, Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital; D.J. Clauw, MD, University of Michigan; D.H. Solomon, MD, MPH, Division of Rheumatology, Brigham and Women's Hospital
| | - Robert R Edwards
- From the Division of Rheumatology, Immunology and Allergy, and Department of Anesthesiology, Brigham and Women's Hospital; Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Y.C. Lee, MD, MMSc, Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital; E. Massarotti, MD, Division of Rheumatology, Brigham and Women's Hospital; R.R. Edwards, PhD, Pain Management Center, Brigham and Women's Hospital; B. Lu, MD, DrPH, Division of Rheumatology, Brigham and Women's Hospital; C. Liu, PhD, Division of Rheumatology, Brigham and Women's Hospital; Y. Lo, MPH, Division of Rheumatology, Brigham and Women's Hospital; A. Wohlfahrt, BA, Division of Rheumatology, Brigham and Women's Hospital; N.D. Kim, MD, Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital; D.J. Clauw, MD, University of Michigan; D.H. Solomon, MD, MPH, Division of Rheumatology, Brigham and Women's Hospital
| | - Bing Lu
- From the Division of Rheumatology, Immunology and Allergy, and Department of Anesthesiology, Brigham and Women's Hospital; Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Y.C. Lee, MD, MMSc, Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital; E. Massarotti, MD, Division of Rheumatology, Brigham and Women's Hospital; R.R. Edwards, PhD, Pain Management Center, Brigham and Women's Hospital; B. Lu, MD, DrPH, Division of Rheumatology, Brigham and Women's Hospital; C. Liu, PhD, Division of Rheumatology, Brigham and Women's Hospital; Y. Lo, MPH, Division of Rheumatology, Brigham and Women's Hospital; A. Wohlfahrt, BA, Division of Rheumatology, Brigham and Women's Hospital; N.D. Kim, MD, Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital; D.J. Clauw, MD, University of Michigan; D.H. Solomon, MD, MPH, Division of Rheumatology, Brigham and Women's Hospital
| | - ChihChin Liu
- From the Division of Rheumatology, Immunology and Allergy, and Department of Anesthesiology, Brigham and Women's Hospital; Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Y.C. Lee, MD, MMSc, Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital; E. Massarotti, MD, Division of Rheumatology, Brigham and Women's Hospital; R.R. Edwards, PhD, Pain Management Center, Brigham and Women's Hospital; B. Lu, MD, DrPH, Division of Rheumatology, Brigham and Women's Hospital; C. Liu, PhD, Division of Rheumatology, Brigham and Women's Hospital; Y. Lo, MPH, Division of Rheumatology, Brigham and Women's Hospital; A. Wohlfahrt, BA, Division of Rheumatology, Brigham and Women's Hospital; N.D. Kim, MD, Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital; D.J. Clauw, MD, University of Michigan; D.H. Solomon, MD, MPH, Division of Rheumatology, Brigham and Women's Hospital
| | - Yuanyu Lo
- From the Division of Rheumatology, Immunology and Allergy, and Department of Anesthesiology, Brigham and Women's Hospital; Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Y.C. Lee, MD, MMSc, Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital; E. Massarotti, MD, Division of Rheumatology, Brigham and Women's Hospital; R.R. Edwards, PhD, Pain Management Center, Brigham and Women's Hospital; B. Lu, MD, DrPH, Division of Rheumatology, Brigham and Women's Hospital; C. Liu, PhD, Division of Rheumatology, Brigham and Women's Hospital; Y. Lo, MPH, Division of Rheumatology, Brigham and Women's Hospital; A. Wohlfahrt, BA, Division of Rheumatology, Brigham and Women's Hospital; N.D. Kim, MD, Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital; D.J. Clauw, MD, University of Michigan; D.H. Solomon, MD, MPH, Division of Rheumatology, Brigham and Women's Hospital
| | - Alyssa Wohlfahrt
- From the Division of Rheumatology, Immunology and Allergy, and Department of Anesthesiology, Brigham and Women's Hospital; Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Y.C. Lee, MD, MMSc, Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital; E. Massarotti, MD, Division of Rheumatology, Brigham and Women's Hospital; R.R. Edwards, PhD, Pain Management Center, Brigham and Women's Hospital; B. Lu, MD, DrPH, Division of Rheumatology, Brigham and Women's Hospital; C. Liu, PhD, Division of Rheumatology, Brigham and Women's Hospital; Y. Lo, MPH, Division of Rheumatology, Brigham and Women's Hospital; A. Wohlfahrt, BA, Division of Rheumatology, Brigham and Women's Hospital; N.D. Kim, MD, Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital; D.J. Clauw, MD, University of Michigan; D.H. Solomon, MD, MPH, Division of Rheumatology, Brigham and Women's Hospital
| | - Nancy D Kim
- From the Division of Rheumatology, Immunology and Allergy, and Department of Anesthesiology, Brigham and Women's Hospital; Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Y.C. Lee, MD, MMSc, Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital; E. Massarotti, MD, Division of Rheumatology, Brigham and Women's Hospital; R.R. Edwards, PhD, Pain Management Center, Brigham and Women's Hospital; B. Lu, MD, DrPH, Division of Rheumatology, Brigham and Women's Hospital; C. Liu, PhD, Division of Rheumatology, Brigham and Women's Hospital; Y. Lo, MPH, Division of Rheumatology, Brigham and Women's Hospital; A. Wohlfahrt, BA, Division of Rheumatology, Brigham and Women's Hospital; N.D. Kim, MD, Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital; D.J. Clauw, MD, University of Michigan; D.H. Solomon, MD, MPH, Division of Rheumatology, Brigham and Women's Hospital
| | - Daniel J Clauw
- From the Division of Rheumatology, Immunology and Allergy, and Department of Anesthesiology, Brigham and Women's Hospital; Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Y.C. Lee, MD, MMSc, Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital; E. Massarotti, MD, Division of Rheumatology, Brigham and Women's Hospital; R.R. Edwards, PhD, Pain Management Center, Brigham and Women's Hospital; B. Lu, MD, DrPH, Division of Rheumatology, Brigham and Women's Hospital; C. Liu, PhD, Division of Rheumatology, Brigham and Women's Hospital; Y. Lo, MPH, Division of Rheumatology, Brigham and Women's Hospital; A. Wohlfahrt, BA, Division of Rheumatology, Brigham and Women's Hospital; N.D. Kim, MD, Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital; D.J. Clauw, MD, University of Michigan; D.H. Solomon, MD, MPH, Division of Rheumatology, Brigham and Women's Hospital
| | - Daniel H Solomon
- From the Division of Rheumatology, Immunology and Allergy, and Department of Anesthesiology, Brigham and Women's Hospital; Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Y.C. Lee, MD, MMSc, Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital; E. Massarotti, MD, Division of Rheumatology, Brigham and Women's Hospital; R.R. Edwards, PhD, Pain Management Center, Brigham and Women's Hospital; B. Lu, MD, DrPH, Division of Rheumatology, Brigham and Women's Hospital; C. Liu, PhD, Division of Rheumatology, Brigham and Women's Hospital; Y. Lo, MPH, Division of Rheumatology, Brigham and Women's Hospital; A. Wohlfahrt, BA, Division of Rheumatology, Brigham and Women's Hospital; N.D. Kim, MD, Division of Rheumatology, Immunology and Allergy, Massachusetts General Hospital; D.J. Clauw, MD, University of Michigan; D.H. Solomon, MD, MPH, Division of Rheumatology, Brigham and Women's Hospital
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Jo CH, Shin JS, Kim JE, Oh S. Macroscopic and microscopic assessments of the glenohumeral and subacromial synovitis in rotator cuff disease. BMC Musculoskelet Disord 2015; 16:272. [PMID: 26423256 PMCID: PMC4589965 DOI: 10.1186/s12891-015-0740-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022] Open
Abstract
Background Whereas synovitis is one of most common findings during arthroscopic surgery in patients with rotator cuff diseases, no study has investigated its characteristics. We propose a macroscopic assessment system for investigating the characteristics of synovitis. Methods Fifty-four patients with a full-thickness rotator cuff tear undergoing arthroscopic rotator cuff repair with an average age of 62.5 ± 7.0 years were included. For the macroscopic assessment, 3 parameters, villous hypertrophy, hyperemia, and density, were measured and translated into grades in 3 regions-of-interest (ROI) in the glenohumeral joint and 4 ROIs in the subacromial space. For the microscopic assessments, 4 commonly used microscopic assessment systems were used. The reliability and association between the macroscopic and microscopic assessments were investigated. Results The inter- and intra-observer reliability of all of the macroscopic and microscopic assessments were excellent. The severity of synovitis was significantly greater in the glenohumeral joint than that in the subacromial space, 1.54 ± 0.61 versus 0.94 ± 0.56 (p < 0.001). Synovitis varied with respect to location, and was generally more severe near the tear with the macroscopic assessment system. Meanwhile, none of the microscopic assessment systems demonstrated differences between different ROIs in both the glenohumeral joint and the subacromial space. Conclusions The macroscopic assessment system for synovitis in rotator cuff disease in this study showed excellent reliability. It critically described characteristics of synovitis that microscopic assessment systems could not. Therefore, this system could be a useful tool for investigating synovitis in rotator cuff disease.
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Affiliation(s)
- Chris H Jo
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| | - Ji Sun Shin
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| | - Ji Eun Kim
- Department of Pathology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| | - Sohee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Korea.
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Fiest K, Fisk J, Patten S, Tremlett H, Wolfson C, Warren S, McKay K, Berrigan L, Marrie R. Comorbidity is associated with pain-related activity limitations in multiple sclerosis. Mult Scler Relat Disord 2015; 4:470-476. [DOI: 10.1016/j.msard.2015.07.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/25/2015] [Accepted: 07/23/2015] [Indexed: 01/10/2023]
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Druce KL, Jones GT, Macfarlane GJ, Basu N. Determining Pathways to Improvements in Fatigue in Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Arthritis Rheumatol 2015; 67:2303-10. [DOI: 10.1002/art.39238] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 05/28/2015] [Indexed: 11/08/2022]
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Atzeni F, Masala IF, Salaffi F, Di Franco M, Casale R, Sarzi-Puttini P. Pain in systemic inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2015; 29:42-52. [PMID: 26266998 DOI: 10.1016/j.berh.2015.04.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The sometimes intense, persistent and disabling pain associated with rheumatoid arthritis (RA) and spondyloarthritis frequently has a multifactorial, simultaneously central and peripheral origin, and it may be due to currently active inflammation or joint damage and tissue destruction caused by a previous inflammatory condition. The symptoms of inflammatory pain symptoms can be partially relieved by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in central pain regulation mechanisms, as in the case of the chronic widespread pain (CWP) characterising fibromyalgia. The importance of distinguishing CWP from inflammatory pain is underlined by the fact that drugs such as tumour necrosis factor inhibitors are expensive, and direct costs are higher in patients with concomitant CWP than in those without. The management of pain requires a combination approach that includes pharmacological analgesia, and biological and non-biological treatments because, although joint replacement surgery can significantly improve RA-related pain, it may only be available to patients with the most severe advanced disease.
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Affiliation(s)
| | | | - Fausto Salaffi
- Chair of Rheumatology, Università Politecnica delle Marche, Italy
| | | | - Roberto Casale
- Department of Clinical Neurophysiology and Pain Rehabilitation Unit (RC), Foundation Salvatore Maugeri IRCCS, Montescano, Italy
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Gao XH, Gao R, Tian YZ, McGonigle P, Barrett JE, Dai Y, Hu H. A store-operated calcium channel inhibitor attenuates collagen-induced arthritis. Br J Pharmacol 2015; 172:2991-3002. [PMID: 25651822 DOI: 10.1111/bph.13104] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 01/20/2015] [Accepted: 01/27/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Store-operated calcium (SOC) channels are thought to play a critical role in immune responses, inflammatory diseases and chronic pain. The aim of this study was to explore the potential role and mechanisms of SOC channels in collagen-induced arthritis (CIA). EXPERIMENTAL APPROACH The CIA mouse model was used to examine the effects of the SOC channel inhibitor YM-58483 on CIA and arthritic pain. Hargreaves' and von Frey hair tests were conducted to measure thermal and mechanical sensitivities of hind paws. elisa was performed to measure cytokine production, and haematoxylin and eosin staining was used to assess knee histological changes. Western blot analysis was performed to examine protein levels. KEY RESULTS Pretreatment with 5 or 10 mg · kg(-1) of YM-58483 reduced the incidence of CIA, prevented the development of inflammation and pain hypersensitivity and other signs and features of arthritis disease. Similarly, treatment with YM-58483 after the onset of CIA: (i) reversed the clinical scores; (ii) reduced paw oedema; (iii) attenuated mechanical and thermal hypersensitivity; (iv) improved spontaneous motor activity; (v) decreased periphery production of IL-1β, IL-6 and TNF-α; and (vi) reduced spinal activation of ERK and calmodulin-dependent PKII (CaMKIIα). CONCLUSIONS AND IMPLICATIONS This study provides the first evidence that inhibition of SOC entry prevents and relieves rheumatoid arthritis (RA) and arthritic pain. These effects are probably mediated by a reduction in cytokine levels in the periphery and activation of ERK and CaMKIIα in the spinal cord. These results suggest that SOC channels are potential drug targets for the treatment of RA.
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Affiliation(s)
- X H Gao
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, USA.,Department of Pharmacology of Chinese Materia Medica, China Pharmaceutical University, Nanjing, China
| | - R Gao
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Y Z Tian
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - P McGonigle
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - J E Barrett
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Y Dai
- Department of Pharmacology of Chinese Materia Medica, China Pharmaceutical University, Nanjing, China
| | - H Hu
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, USA
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Su J, Gao T, Shi T, Xiang Q, Xu X, Wiesenfeld-Hallin Z, Hökfelt T, Svensson CI. Phenotypic changes in dorsal root ganglion and spinal cord in the collagen antibody-induced arthritis mouse model. J Comp Neurol 2015; 523:1505-28. [DOI: 10.1002/cne.23749] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 12/26/2014] [Accepted: 01/24/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Jie Su
- Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm 171 77 Sweden
| | - Tianle Gao
- Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm 171 77 Sweden
| | - Tiejun Shi
- Department of Neuroscience; Karolinska Institutet; Stockholm 171 77 Sweden
| | - Qiong Xiang
- Department of Neuroscience; Karolinska Institutet; Stockholm 171 77 Sweden
| | - Xiaojun Xu
- Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm 171 77 Sweden
| | | | - Tomas Hökfelt
- Department of Neuroscience; Karolinska Institutet; Stockholm 171 77 Sweden
| | - Camilla I. Svensson
- Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm 171 77 Sweden
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Gris G, Merlos M, Vela JM, Zamanillo D, Portillo-Salido E. S1RA, a selective sigma-1 receptor antagonist, inhibits inflammatory pain in the carrageenan and complete Freund's adjuvant models in mice. Behav Pharmacol 2014; 25:226-35. [PMID: 24776490 DOI: 10.1097/fbp.0000000000000038] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The therapeutic potential of S1RA (E-52862), a selective sigma-1 receptor (σ1R) antagonist, has been explored in experimental neuropathic pain, but not in inflammatory pain models. The present study investigated the effect of the intraperitoneal administration of S1RA on the hind paw withdrawal response to thermal and mechanical stimulation following an intraplantar injection of carrageenan (CARR) and complete Freund's adjuvant (CFA), which are two well-characterized models of acute and chronic inflammatory pain, respectively. S1RA fully reversed both mechanical [dose of drug that produced half of its maximal response (ED50)=35.9 and 42.1 mg/kg for CARR-induced and CFA-induced pain, respectively] and thermal (ED50=27.9 mg/kg, CARR) hypersensitivity, whereas ibuprofen (CARR, mechanical allodynia) and celecoxib (CARR, thermal hyperalgesia; CFA, mechanical allodynia) failed to reach maximum efficacy. Morphine also showed maximum efficacy in all tests. Unlike celecoxib and ibuprofen, which decreased paw volume significantly, CARR-induced paw oedema was not reduced by S1RA and morphine, thus suggesting that the antinociceptive effect of S1RA does not involve a major anti-inflammatory (antioedema) action. S1RA was devoid of efficacy when administered to σ1R knockout mice, thus suggesting the involvement of σ1R in the antinociceptive effects exerted by S1RA. We conclude that S1RA represents a promising novel analgesic therapy for inflammatory pain.
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Affiliation(s)
- Georgia Gris
- Drug Discovery and Preclinical Development, Esteve, Parc Científic de Barcelona, Barcelona, Spain
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Walsh DA, McWilliams DF. Mechanisms, impact and management of pain in rheumatoid arthritis. Nat Rev Rheumatol 2014; 10:581-92. [PMID: 24861185 DOI: 10.1038/nrrheum.2014.64] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
People with rheumatoid arthritis (RA) identify pain as their most important symptom, one that often persists despite optimal control of inflammatory disease. RA pain arises from multiple mechanisms, involving inflammation, peripheral and central pain processing and, with disease progression, structural change within the joint. Consequently, RA pain has a wide range of characteristics-constant or intermittent, localized or widespread-and is often associated with psychological distress and fatigue. Dominant pain mechanisms in an individual are identified by critical evaluation of clinical symptoms and signs, and by laboratory and imaging tests. Understanding these mechanisms is essential for effective management, although evidence from preclinical models should be interpreted with caution. A range of pharmacological analgesic and immunomodulatory agents, psychological interventions and surgery may help manage RA pain. Pain contributes importantly to the clinical assessment of inflammatory disease activity, and noninflammatory components of RA pain should be considered when gauging eligibility for or response to biologic agents. Further randomized controlled trials are required to determine the optimal usage of analgesics in RA, and novel agents with greater efficacy and lower propensity for adverse events are urgently needed. Meanwhile, targeted use of existing treatments could reduce pain in people with RA.
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Affiliation(s)
- David A Walsh
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
| | - Daniel F McWilliams
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
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