Nociplastic pain in axial spondyloarthritis and psoriatic arthritis: role of JAK kinases in immunopathology and therapeutic impact of JAK inhibitors.

IF 3.9 3区医学 Q2 IMMUNOLOGY Expert Review of Clinical Immunology Pub Date : 2024-09-08 DOI:10.1080/1744666X.2024.2400294

Natalya Horbal, Walter P Maksymowych

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Abstract

Introduction: Pain in both peripheral and axial joints is a major symptom in patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). Emerging evidence demonstrates pain mechanisms, beyond those related to inflammation or joint damage, based on aberrant processing of nociceptive stimuli peripherally as well as centrally. The Janus kinase/signal transducers and activators of transcription (JAK-STAT) signaling pathway has been implicated in the processing of pain beyond its role in mediating inflammation and inhibitors of this pathway approved for the treatment of axSpA and PsA have been shown to alleviate a broad array of pain outcomes in both axial and peripheral joints.

Areas covered: We review recent definitions and standardization of the nomenclature for categorizing chronic pain according to causality, assessment tools to evaluate nociplastic pain, the pathophysiologic role of JAK-STAT signaling in nociplastic pain, evidence for the presence of nociplastic pain in axSpA and PsA, and the impact of JAK inhibitors (JAKi) on pain outcomes in clinical trials (PubMed: 01/01/2019-04/01-2024).

Expert opinion: Nociplastic pain assessment has been confined almost entirely to the use of a limited number of questionnaires in cross-sectional studies of these diseases. Though effective for alleviating pain, it is unclear if JAKi specifically impact nociplastic pain.

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轴性脊柱关节炎和银屑病关节炎中的非关节痛：JAK 激酶在免疫病理学中的作用以及 JAK 抑制剂的治疗效果。

导言：外周和轴关节疼痛是银屑病关节炎（PsA）和轴性脊柱关节炎（axSpA）患者的主要症状。新的证据表明，疼痛机制与炎症或关节损伤无关，而是基于外周和中枢对痛觉刺激的异常处理。Janus 激酶/信号转导和转录激活因子（JAK-STAT）信号通路在介导炎症的作用之外，还与疼痛的处理有牵连，已被批准用于治疗 axSpA 和 PsA 的该通路抑制剂已被证明可减轻轴关节和外周关节的一系列疼痛结果：我们回顾了根据因果关系对慢性疼痛进行分类的最新定义和术语标准化、评估非痉挛性疼痛的评估工具、JAK-STAT信号传导在非痉挛性疼痛中的病理生理作用、axSpA和PsA中存在非痉挛性疼痛的证据，以及临床试验中JAK抑制剂（JAKi）对疼痛结果的影响（PubMed：01/01/2019-04/01-2024）：在这些疾病的横断面研究中，非关节性疼痛评估几乎完全局限于使用数量有限的调查问卷。尽管JAKi能有效缓解疼痛，但目前尚不清楚它是否会对非结节性疼痛产生具体影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Clinical Immunology IMMUNOLOGY-

CiteScore

7.60

自引率

2.30%

发文量

221

审稿时长

6-12 weeks

期刊介绍： Expert Review of Clinical Immunology (ISSN 1744-666X) provides expert analysis and commentary regarding the performance of new therapeutic and diagnostic modalities in clinical immunology. Members of the International Editorial Advisory Panel of Expert Review of Clinical Immunology are the forefront of their area of expertise. This panel works with our dedicated editorial team to identify the most important and topical review themes and the corresponding expert(s) most appropriate to provide commentary and analysis. All articles are subject to rigorous peer-review, and the finished reviews provide an essential contribution to decision-making in clinical immunology. Articles focus on the following key areas: • Therapeutic overviews of specific immunologic disorders highlighting optimal therapy and prospects for new medicines • Performance and benefits of newly approved therapeutic agents • New diagnostic approaches • Screening and patient stratification • Pharmacoeconomic studies • New therapeutic indications for existing therapies • Adverse effects, occurrence and reduction • Prospects for medicines in late-stage trials approaching regulatory approval • Novel treatment strategies • Epidemiological studies • Commentary and comparison of treatment guidelines Topics include infection and immunity, inflammation, host defense mechanisms, congenital and acquired immunodeficiencies, anaphylaxis and allergy, systemic immune diseases, organ-specific inflammatory diseases, transplantation immunology, endocrinology and diabetes, cancer immunology, neuroimmunology and hematological diseases.