Osteoartritte Nöropatik Ağrı

Yıl 2019, Cilt: 41 Sayı: 2, 196 - 202, 01.04.2019

Nurhan Barutçu Merih Özgen

https://doi.org/10.20515/otd.445722

Öz

Osteoartrit, eklem hastalıkları
ve tüm kronik hastalıklar arasında yaygın görülen bir hastalıktır. Diz osteoartriti,
toplumda büyük bir populasyonu etkileyerek disabiliteye neden olur. Ağrı
osteoartritin ana semptomudur. Ağrının altta yatan mekanizmasını anlamak ve
buna uygun şekilde tedavi programlarını oluşturmak klinisyenlerin hedefi
olmalıdır. Yeni araştırmalar, osteoartrit ağrısının patofizyolojisi ile ilgili
bilgilerimizi arttırmıştır. Lokal eklem inflamasyonu ve eklemdeki yapısal
değişiklikler nosiseptif sürece etki eder. Osteoartrit ağrısında periferik
mekanizmaların yanında santral mekanizmalar da bulunmaktadır. Osteoartrit
ağrısının hastalığın ilerlemesiyle nosiseptif ağrıdan nöropatik ağrıya
dönüştüğü çalışmalarda belirtilmektedir. Bu durum konvansiyonel tedaviye yanıtı
güçleştirmektedir. Çeşitli konservatif ve girişimsel tedaviler olmasına rağmen
osteoartrit ağrısının tedavisi yeterli değildir. Etkisiz ağrı yönetimi
osteoartrite bağlı özürlülüğü artırmaktadır. Nöropatik ağrısı olan osteoartrit
hastalarını ayrı bir alt grup olarak tanımak klinisyenlerin semptomların
yönetiminde daha başarılı olmasını sağlayacaktır. Osteoartritte nöropatik
komponent bulunduğuna dair kanıtların artması, osteoartrit ağrısının
tedavisinde santral etkili ilaçlar kullanılmasına neden olmaktadır. Bu ilaçlar
ağrı yönetimi konusunda faydalı olabilmektedir. Bu derlemenin amacı,
osteoartritin kompleks olan ağrısının altında yatan patofizyolojik mekanizmaya
açıklık getirmek ve yeni tedavi stratejileri geliştirmektir. Osteoartritte ağrı
fenotipi klinik olarak doğru sınıflandırılırsa, ağrı yönetimi daha etkili hale
gelebilir ve nöropatik ağrıyı hedefleyen tedavilerle osteoartrit ağrısı kontrol
altına alınabilir. Bu derleme osteoartritte bulunan nöropatik ağrı
mekanizmalarını, tanısını ve tedavisini içermektedir.

Anahtar Kelimeler

osteoartrit, diz osteoartriti, nöropatik ağrı, ağrı

Neuropathic Pain in Osteoarthritis

Öz

Osteoarthritis is a common disease among joint
diseases and all chronic diseases. Knee osteoarthritis affects a large
population of the society and causes disability. Pain is the main symptom of
osteoarthritis. Clinicians must aim  to
understand the underlying mechanisms of pain and to develop suitable treatment methods.
Recent  investigations have improved our
knowledge of the pathophysiology of pain due to osteoarthritis. Local joint
inflammation and structural changes in the joint affect the nociceptive
process. Osteoarthritis pain includes central mechanisms in addition to
peripheral mechanisms. Studies have reported that, type of pain due to
osteoarthritis transforms from nociceptive into neuropathic type by the
progression of  disease. This makes the
respond to conventional treatment to be harder. Although  various conservative and interventional
treatments are used, the management of osteoarthritis pain is stil
contradictory.. Ineffective pain management increases osteoarthritis-related
disability. Determining the osteoarthritis 
patients with neuropathic pain as a spesific group,will help clinicians to
suceed more in management of the symptoms. Increased evidence of neuropathic
component in osteoarthritis leads to the use of centrally acting drugs in the
treatment of osteoarthritis pain. These medicines can be beneficial for pain
management. The purpose of this review is to clarify the underlying pathophysiological
mechanism of complex pain of osteoarthritis and to develop new treatment
strategies. If the pain phenotype of osteoarthritis is classified clinically in
the correct way, pain management will be able to work more efficiently and  osteoarthritis pain can be controlled with
treatments targeting neuropathic pain. This review includes neuropathic pain
mechanisms, diagnosis and treatment of the osteoarthritis.

Anahtar Kelimeler

osteoarthritis, knee osteoarthritis, neuropathic pain, pain

Kaynakça

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