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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 596 -600. doi: 10.3877/cma.j.issn.1674-134X.2021.05.011

综述

膝骨关节炎疼痛机制研究进展
李健雄1, 张程1, 辛鹏飞1, 李子祺2, 庄至坤3, 何伟4, 魏秋实2,()   
  1. 1. 510378 广州中医药大学骨伤科研究院;510405 广州中医药大学第一临床医学院
    2. 510378 广州中医药大学骨伤科研究院;510378 广州中医药大学第三附属医院关节中心
    3. 510405 广州中医药大学第一临床医学院;362000 福建中医药大学附属泉州市正骨医院关节科
    4. 510378 广州中医药大学骨伤科研究院
  • 收稿日期:2021-03-14 出版日期:2021-10-01
  • 通信作者: 魏秋实

Research progress on pain mechanism of knee osteoarthritis

Jianxiong Li1, Cheng Zhang1, Pengfei Xin1, Ziqi Li2, Zhikun Zhuang3, Wei He4, Qiushi Wei2,()   

  1. 1. Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, Guangzhou 510378, China; First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
    2. Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, Guangzhou 510378, China; Department of Joint Diseases, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510378, China
    3. First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Department of Orthopedics, Quanzhou Orthopedic Traumatological Hospital, Fujian Traditional Chinese Medicine University, Quanzhou 362000, China
    4. Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, Guangzhou 510378, China
  • Received:2021-03-14 Published:2021-10-01
  • Corresponding author: Qiushi Wei
引用本文:

李健雄, 张程, 辛鹏飞, 李子祺, 庄至坤, 何伟, 魏秋实. 膝骨关节炎疼痛机制研究进展[J/OL]. 中华关节外科杂志(电子版), 2021, 15(05): 596-600.

Jianxiong Li, Cheng Zhang, Pengfei Xin, Ziqi Li, Zhikun Zhuang, Wei He, Qiushi Wei. Research progress on pain mechanism of knee osteoarthritis[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(05): 596-600.

膝骨关节炎是一种慢性、退行性、累及关节内所有结构的疾病。疼痛、活动受限、关节畸形等是膝骨关节炎患者的主要症状。目前膝骨关节炎疼痛的具体机制尚不明确,导致对膝骨关节炎的治疗效果不尽人意,疼痛是患者接受关节置换手术的主要原因之一。本文通过文献回顾,总结出膝关节内关节软骨、软骨下骨、滑膜及髌下脂肪垫等组织病变可能导致炎症介质等分子的产生,使关节内发生炎症反应;病变也可能会使关节内机械应力改变,均可刺激感觉神经产生疼痛。神经功能改变可能存在于膝骨关节炎整个病程,感觉神经长期受到刺激使神经功能发生改变,产生提高疼痛敏感性、放大疼痛区域等协同效应。

Knee osteoarthritis is a chronic, degenerative disease involving all structures in the joint. Pain, limitation of movement and joint deformity are the main symptoms of knee osteoarthritis. At present, the specific mechanism of knee osteoarthritis pain had not been fully elucidated, resulting in the treatment of knee osteoarthritis is not satisfactory. Pain is one of the main reasons for patients to receive joint replacement surgery. Based on the review of the literature, it is concluded that the pathological changes of articular cartilage, subchondral bone, synovium and infrapatellar fat pad of the knee joint may lead to the production of inflammatory mediators and other molecules, which may cause inflammatory reaction in the articulation and stimulate the sensory nerve. The pathological changes may also change the mechanical stress in the joint, which can stimulate the sensory nerve to cause pain. The changes of nerve function may exist in the whole course of knee osteoarthritis. Long-term stimulation of the sensory nerve changes the neurological function, resulting in synergistic effects such as improving pain sensitivity and magnifying the pain area.

图1 关节软骨及软骨下骨病变过程
[1]
O′Neill TW, Felson DT. Mechanisms of Osteoarthritis (OA) Pain[J]. Curr Osteoporos Rep, 2018, 16(5): 611-616.
[2]
Hawker GA. Osteoarthritis is a serious disease[J]. Clin Exp Rheumatol, 2019, 37 Suppl 120(5): 3-6.
[3]
Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study[J]. Ann Rheum Dis, 2014, 73(7): 1323-1330.
[4]
Carballo CB, Nakagawa Y, Sekiya I, et al. Basic science of articular cartilage[J]. Clin Sports Med, 2017, 36(3): 413-425.
[5]
Hunter DJ, Bierma-Zeinstra S. Osteoarthritis[J]. Lancet, 2019, 393(10182): 1745-1759.
[6]
Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American college of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee[J]. Arthritis Care Res (Hoboken), 2020, 72(2): 149-162.
[7]
Carr AJ, Robertsson O, Graves S, et al. Knee replacement[J]. Lancet, 2012, 379(9823): 1331-1340.
[8]
Guilak F. Biomechanical factors in osteoarthritis[J]. Best Pract Res Clin Rheumatol, 2011, 25(6): 815-823.
[9]
Eskelinen A, Tanska P, Florea C, et al. Mechanobiological model for simulation of injured cartilage degradation via pro-inflammatory cytokines and mechanical stimulus[J/OL]. PLOS Comput Biol. 2020, 16(6): e1007998. doi: 10.1371/journal.pcbi.1007998.
[10]
Andriacchi TP, Mündermann A, Smith RL, et al. A framework for the in vivo pathomechanics of osteoarthritis at the knee[J]. Ann Biomed Eng, 2004, 32(3): 447-457.
[11]
Loeser RF, Collins JA, Diekman BO. Ageing and the pathogenesis of osteoarthritis[J]. Nat Rev Rheumatol, 2016, 12(7): 412-420.
[12]
Fu K, Robbins SR, Mcdougall JJ. Osteoarthritis: the Genesis of pain[J]. Rheumatology (Oxford), 2018, 57(suppl_4): iv43-iv50.
[13]
Mapp PI, Walsh DA. Mechanisms and targets of angiogenesis and nerve growth in osteoarthritis[J]. Nat Rev Rheumatol, 2012, 8(7): 390-398.
[14]
Martel-Pelletier J, Barr AJ, Cicuttini FM, et al. Osteoarthritis[J/OL]. Nat Rev Dis Primers, 2016, 2: 16072. doi: 10.1038/nrdp.2016.72.
[15]
Zhu S, Zhu J, Zhen G, et al. Subchondral bone osteoclasts induce sensory innervation and osteoarthritis pain[J]. J Clin Invest, 2019, 129(3): 1076-1093.
[16]
Yusuf E, Kortekaas MC, Watt I, et al. Do knee abnormalities visualised on MRI explain knee pain in knee osteoarthritis? A systematic review[J]. Ann Rheum Dis, 2011, 70(1): 60-67.
[17]
Daugaard CL, Riis RG, Bandak E, et al. Perfusion in bone marrow lesions assessed on DCE-MRI and its association with pain in knee osteoarthritis: a cross-sectional study[J]. Skeletal Radiol, 2020, 49(5): 757-764.
[18]
Alliston T, Hernandez CJ, Findlay DM, et al. Bone marrow lesions in osteoarthritis: What lies beneath[J]. J Orthop Res, 2018, 36(7): 1818-1825.
[19]
Korompilias AV, Karantanas AH, Lykissas MG, et al. Bone marrow edema syndrome[J]. Skeletal Radiol, 2009, 38(5): 425-436.
[20]
曹小燕,李凤霞,叶青.唑来膦酸钠抗骨质疏松治疗膝骨关节炎的疗效观察[J].湖北医药学院学报201433(1):56-58.
[21]
Cai G, Aitken D, Laslett LL, et al. Effect of intravenous zoledronic acid on tibiofemoral cartilage volume among patients with knee osteoarthritis with bone marrow lesions: a randomized clinical trial[J]. JAMA, 2020, 323(15): 1456-1466.
[22]
Belluzzi E, Stocco E, Pozzuoli A, et al. Contribution of infrapatellar fat pad and synovial membrane to knee osteoarthritis pain[J/OL]. Biomed Res Int, 2019, (1): 6390182. doi: 10.1155/2019/6390182.
[23]
Mathiessen A, Conaghan PG. Synovitis in osteoarthritis: current understanding with therapeutic implications[J/OL]. Arthritis Res Ther, 2017, 19(1): 18. doi:10.1186/s13075-017-1229-9.
[24]
Scanzello CR, Goldring SR. The role of synovitis in osteoarthritis pathogenesis[J]. Bone, 2012, 51(2, SI): 249-257.
[25]
Thudium CS, Löfvall H, Karsdal MA, et al. Protein biomarkers associated with pain mechanisms in osteoarthritis[J]. J Proteomics, 2019, 190(SI): 55-66.
[26]
Nwosu LN, Mapp PI, Chapman V, et al. Relationship between structural pathology and pain behaviour in a model of osteoarthritis (OA)[J]. Osteoarthritis Cartilage, 2016, 24(11): 1910-1917.
[27]
Hoshino T, Tsuji K, Onuma H, et al. Persistent synovial inflammation plays important roles in persistent pain development in the rat knee before cartilage degradation reaches the subchondral bone[J/OL]. BMC Musculoskelet Disord, 2018, 19(1): 291. doi: 10.1186/s12891-018-2221-5.
[28]
Sarmanova A, Hall M, Fernandes GS, et al. Association between ultrasound-detected synovitis and knee pain: a population-based case-control study with both cross-sectional and follow-up data[J/OL]. Arthritis Res Ther, 2017, 19(1): 281. doi: 10.1186/s13075-017-1486-7.
[29]
Wallace G, Cro S, Dore C, et al. Associations between clinical evidence of inflammation and synovitis in symptomatic knee osteoarthritis:a cross-sectional substudy[J]. Arthritis Care Res (Hoboken), 2017, 69(9): 1340-1348.
[30]
Jacobson JA, Lenchik L, Ruhoy MK, et al. Mr imaging of the infrapatellar fat pad of Hoffa[J]. Radiographics, 1997, 17(3): 675-691.
[31]
Sbarbati A, Accorsi D, Benati D, et al. Subcutaneous adipose tissue classification[J/OL]. Eur J Histochem, 2010, 54(4): e48: 226-230. doi: 10.4081/ejh.2010.e48.
[32]
Eymard F, Pigenet A, Citadelle D, et al. Knee and hip intra-articular adipose tissues (IAATs) compared with autologous subcutaneous adipose tissue: a specific phenotype for a central player in osteoarthritis[J]. Ann Rheum Dis, 2017, 76(6): 1142-1148.
[33]
Favero M, El-Hadi H, Belluzzi E, et al. Infrapatellar fat pad features in osteoarthritis: a histopathological and molecular study[J]. Rheumatology (Oxford), 2017, 56(10): 1784-1793.
[34]
Barboza E, Hudson J, Chang WP, et al. Profibrotic infrapatellar fat pad remodeling without M1 macrophage polarization precedes knee osteoarthritis in mice with Diet-Induced obesity[J]. Arthritis Rheumatol, 2017, 69(6): 1221-1232.
[35]
Han W, Aitken D, Zhu Z, et al. Hypointense signals in the infrapatellar fat pad assessed by magnetic resonance imaging are associated with knee symptoms and structure in older adults: a cohort study[J/OL]. Arthritis Res Ther, 2016, 18(1): 234. doi: 10.1186/s13075-016-1130-y.
[36]
Macchi V, Stocco E, Stecco C, et al. The infrapatellar fat pad and the synovial membrane: an anatomo-functional unit[J]. J Anat, 2018, 233(2): 146-154.
[37]
Onuma H, Tsuji K, Hoshino T, et al. Fibrotic changes in the infrapatellar fat pad induce new vessel formation and sensory nerve fiber endings that associate prolonged pain[J]. J Orthop Res, 2020, 38(6): 1296-1306.
[38]
Aikawa J, Uchida K, Takano S, et al. Expression of calcitonin gene-related peptide in the infrapatellar fat pad in knee osteoarthritis patients[J/OL]. J Orthop Surg Res, 2017, 12(1): 65. doi: 10.1186/s13018-017-0568-1.
[39]
Sun C, Zhang X, Lee WG, et al. Infrapatellar fat pad resection or preservation during total knee arthroplasty: a meta-analysis of randomized controlled trials[J/OL]. J Orthop Surg Res, 2020, 15(1): 297. doi: 10.1186/s13018-020-01823-2.
[40]
Song J, Chang AH, Chang RW, et al. Relationship of knee pain to time in moderate and light physical activities: data from Osteoarthritis Initiative[J]. Semin Arthritis Rheum, 2018, 47(5): 683-688.
[41]
Liu-Bryan R, Terkeltaub R. Emerging regulators of the inflammatory process in osteoarthritis[J]. Nat Rev Rheumatol, 2015, 11(1): 35-44.
[42]
Malfait AM, Schnitzer TJ. Towards a mechanism-based approach to pain management in osteoarthritis[J]. Nat Rev Rheumatol, 2013, 9(11): 654-664.
[43]
Syx D, Tran PB, Miller RE, et al. Peripheral mechanisms contributing to osteoarthritis pain[J/OL]. Curr Rheumatol Rep, 2018, 20(2): 9. doi: 10.1007/s11926-018-0716-6.
[44]
Soni A, Wanigasekera V, Mezue M, et al. Central sensitization in knee osteoarthritis: relating presurgical brainstem neuroimaging and pain detect-based patient stratification to arthroplasty outcome[J]. Arthritis Rheumatol, 2019, 71(4): 550-560.
[45]
王波,余楠生.膝骨关节炎阶梯治疗专家共识(2018年版)[J/CD].中华关节外科杂志(电子版)201913(1):124-130.
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