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

• 1. Gümüş K, Ünsal A. Osteoartritli Bireylerin Günlük Yaşam Aktivitelerinin Değerlendirilmesi. Turk Osteoporoz Dergisi. 2014; 20(3):117-24.
• 2. Perrot, S. Osteoarthritis pain. Best Pract Res Clin Rheumatol 2015;29(1): 90-97.
• 3. Goldring MB, Otero M. Inflammation in osteoarthritis. Curr Opin Rheumatol 2011;23(5):471-8.
• 4. Altan L, Kasapoğlu Aksoy M. Kronik Ağrı Tanımı ve Epidemiyolojisi. Turkiye Klinikleri J PM&R-Special Topics 2017;10(3):229-33.
• 5. Daousi C, MacFarlane IA, Woodward A, Nurmikko TJ, Bundred PE, Benbow SJ. Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. Diabet Med 2004;21(9):976-82.
• 6. Finan PH, Buenaver LF, Bounds SC, Hussain S, Park RJ, Haque UJ et al. Discordance between pain and radiographic severity in knee osteoarthritis: findings from quantitative sensory testing of central sensitization. Arthritis & Rheum. 2013;65(2): 363-72.
• 7. Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord. 2008;9:116.
• 8. Dieppe, PA. Relationship between symptoms and structural change in osteoarthritis: what are the important targets for therapy?.J Rheumatol. 2005;32(6):1147-1149.
• 9. Moreton BJ, Tew V, das Nair R, Wheeler M, Walsh DA, Lincoln NB. Pain phenotype in patients with knee osteoarthritis:Classification and measurement properties of painDETECT and self‐report leeds assessment of neuropathic symptoms and. signs scale in a cross‐sectional study. Arthritis Care Res (Hoboken). 2015;67(4):519-28.
• 10. Thakur M, Dickenson AH, Baron R. Osteoarthritis pain: nociceptive or neuropathic?. Nat Rev Rheumatol 2014;10(6): 374.
• 11. French HP, Smart KM, Doyle F. Prevalence of neuropathic pain in knee or hip osteoarthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. 2017;47 (1): 1-8.
• 12. Fingleton C, Smart K, Moloney N, Fullen BM, Doody C. Pain sensitization in people with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2015;23(7):1043-56.
• 13. Zhang RX, Ren K, Dubner R. Osteoarthritis pain mechanisms: basic studies in animal models. Osteoarthritis Cartilage 2013;21(9):1308-15. 14. Ivanavicius SP, Ball AD, Heapy CG, Westwood FR, Murray F, Read SJ. Structural pathology in a rodent model of osteoarthritis is associated with neuropathic pain: increased expression of ATF-3 and pharmacological characterisation. Pain 2007;128(3):272-82.
• 15. Dimitroulas T, Duarte RV, Behura A, Kitas GD, Raphael JH. Neuropathic pain in osteoarthritis: a review of pathophysiological mechanisms and implications for treatment. Semin Arthritis Rheum. 2014;44(2):145-54.
• 16. Ochiai N, Ohtori S, Sasho T, et al. Extracorporeal shock wave therapy improves motor dysfunction and pain originating from knee osteoarthritis in rats. Osteoarthritis Cartilage 2007;15:1093-6.
• 17. Thakur M, Rahman W ,Hobbs C, Dickenson AH, Bennett DLH. Characterisation of a peripheral neuropathic component of the rat monoiodoacetate model of osteoarthritis. PloS one 7.3 (2012): e33730.
• 18. Im HJ, Kim JS, Li X, Kotwal N, Sumner DR, van Wijnen AJ. et all. Alteration of sensory neurons and spinal response to an experimental osteoarthritis pain model. Arthritis Rheum. 2010;62(10):2995-3005.
• 19. Orita S, Ishikawa T, Miyagi M, Ochiai N, Inoue G, Eguchi Y. et al. Pain-related sensory innervation in monoiodoacetate-induced osteoarthritis in rat knees that gradually develops neuronal injury in addition to inflammatory pain. BMC Musculoskelet Disord. 2011;12:134
• 20. Kelly S, Chapman RJ, Woodhams S, Sagar DR,Turner J,Burston JJ et al. Increased function of pronociceptive TRPV1 at the level of the joint in a rat model of osteoarthritis pain. Ann Rheum Dis 2015;74:252–59.
• 21. Ohtori S, Inoue G, Orita S, Takaso M, Eguchi Y, Ochiai N, et al. Efficacy of combination of meloxicam and pregabalin for pain in knee osteoarthritis.Yonsei Med J. 2013 ;54(5):1253-8. 22. Schaible HG. Mechanisms of chronic pain in osteoarthritis. Curr Rheumatol Rep. 2012 ;14(6):549-56.
• 23. Hochman JR, Davis AM, Elkayam J, Gagliese L, Hawker GA. Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis.Osteoarthritis Cartilage. 2013 ;21(9):1236-42.
• 24. Schaible HG, Richter F, Ebersberger A, Boettger MK, Vanegas H, Natura G. et al. Joint pain. Exp Brain Res. 2009;196:153–162. 25. Arendt-Nielsen L, Nie H, Laursen MB, Laursen BS, Madeleine P, Simonsen OH. et al. Sensitization in patients with painful knee osteoarthritis.Pain. 2010 Jun;149(3):573-81.
• 26. Imamura M, Imamura ST, Kaziyama HH, Targino RA, Hsing WT, de Souza LP et al. Impact of nervous system hyperalgesia on pain, disability, and quality of life in patients with knee osteoarthritis: a controlled analysis. Arthritis Rheum. 2008 Oct 15;59(10):1424-31
• 27. Wylde V, Palmer S, Learmonth ID, Dieppe P. Somatosensory abnormalities in knee OA. Rheumatology (Oxford). 2012 Mar;51(3):535-43. 28. Graven-Nielsen T, Wodehouse T, Langford RM, Arendt-Nielsen L, Kidd BL. Normalization of widespread hyperesthesia and facilitated spatial summation of deep‐tissue pain in knee osteoarthritis patients after knee replacement. Arthritis Rheum. 2012 Sep;64(9):2907-16
• 29. Harden RN, Wallach G, Gagnon CM, Zereshki A, Mukai A, Saracoglu M, et al. The osteoarthritis knee model: psychophysical characteristics and putative outcomes. J Pain. 2013 Mar;14(3):281-9.
• 30. Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW et al. Neuropathic pain redefinition and a grading system for clinical and research purposes. Neurology. 2008 Apr 29;70(18):1630-5.
• 31. Gwilym SE, Keltner JR, Warnaby CE, Carr AJ, Chizh B, Chesse et al. Psychophysical and functional imaging evidence supporting the presence of central sensitization in a cohort of osteoarthritis patients. Arthritis Rheum. 2009 Sep 15;61(9):1226-34.
• 32. Trouvin AP, Perrot S. Pain in osteoarthritis. Implications for optimal management.Joint Bone Spine. 2018 Jul;85(4):429-34.
• 33. Neogi T, Niu J, Arendt-Nielsen L, Scholz J, Frey-Law L, Woolf C. et al. Central sensitization in knee OA: preliminary results from the MOST study. Osteoarthritis Cartilage 2010;18 (2):34.
• 34. Thakur M, Dawes JM, McMahon SB. Genomics of pain in osteoarthritis. Osteoarthritis Cartilage 2013 Sep;21(9):1374-82.
• 35. Hochman JR, Gagliese L, Davis AM, Hawker GA. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis Cartilage. 2011 Jun;19(6):647-54.
• 36. Cruccu, G., et al. "EFNS guidelines on neuropathic pain assessment: revised 2009." European journal of neurology 17.8 (2010): 1010-1018.
• 37. Gilron I, Watson CP, Cahill CM, Moulin DE.Neuropathic pain: a practical guide for the clinician. CMAJ. 2006 Aug 1;175(3):265-75. 38. Hurley MV, Scott DL, Rees J, Newham DJ. Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis. 1997 Nov;56(11):641-8.
• 39. Sharma L, Pai YC, Holtkamp K, Rymer WZ. Is knee joint proprioception worse in the arthritic knee versus the unaffected knee in unilateral knee osteoarthritis? Arthritis Rheum. 1997 Aug;40(8):1518-25.
• 40. Shakoor N, Lee KJ, Fogg LF, Wimmer MA, Foucher KC, Mikolaitis RA, et al. The relationship of vibratory perception to dynamic joint loading, radiographic severity, and pain in knee osteoarthritis. Arthritis Rheum. 2012 Jan;64(1):181-6.
• 41. Hendiani JA, Westlund KN, Lawand N, Goel N, Lisse J, McNearney T. Mechanical sensation and pain thresholds in patients with chronic arthropathies. J Pain. 2003 May;4(4):203-11.
• 42. Courtney CA, Lewek MD, Witte PO, Chmell SJ, Hornby TG. Heightened flexor withdrawal responses in subjects with knee osteoarthritis. J Pain. 2009 Dec;10(12):1242-9.
• 43. Roubille C, Raynauld JP, Abram F, Paiement P, Dorais M, Delorme P. et al. The presence of meniscal lesions is a strong predictor of neuropathic pain in symptomatic knee osteoarthritis: a cross-sectional pilot study. Arthritis Res Ther. 2014; 16(6): 507.
• 44. Kidd BL, Langford RM, Wodehouse T. Arthritis and pain. Current approaches in the treatment of arthritic pain.Arthritis Res Ther. 2007; 9(3): 214. 45. Melzack R. From the gate to the neuromatrix. Pain. 1999 Aug; 6:121-6.
• 46. Bradley LA, McKendree-Smith NL. Central nervous system mechanisms of pain in fibromyalgia and other musculoskeletal disorders: behavioral and psychologic treatment approaches. Curr Opin Rheumatol. 2002 Jan;14(1):45-51.
• 47. Russell IJ, Michalek JE, Vipraio GA, Fletcher EM, Javors MA, Bowden CA. Platelet 3H-imipramine uptake receptor density and serum serotonin levels in patients with fibromyalgia/fibrositis syndrome. J Rheumatol. 1992 Jan;19(1):104-9.
• 48. Altay Z. Physical Therapy Methods in Neuropathic Pain. J PM&R-Special Topics 2012;5(1):77-9.
• 49. Dworkin RH, O'Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain. 2007 Dec 5;132(3):237-51.
• 50. Telleria-Diaz A, Schmidt M, Kreusch S, Neubert AK, Schache F, Vazquez E, et al. Spinal antinociceptive effects of cyclooxygenase inhibition during inflammation: Involvement of prostaglandins and endocannabinoids.Pain. 2010 Jan;148(1):26-35.