Osteoartritte Nöropatik Ağrı

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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