Молекулярные аспекты управления ревматической болью

Ревматические заболевания (РЗ), в том числе остеоартрит и ревматоидный артрит, – это неинфекционные медленно прогрессирующие неизлечимые воспалительные заболевания, приводящие к длительной инвалидности вследствие поражения опорно-двигательного аппарата. Боль является доминирующим симптомом на любой стадии этих заболеваний, непосредственно связана с функционированием суставов и определяет качество жизни больных. При этом, несмотря на значительные успехи в исследовании роли воспаления и регуляции аутоиммунных процессов, патогенетические механизмы развития и сохранения боли при РЗ малоизученны. В развитии ревматической боли участвуют ноцицептивные механизмы, обусловленные воспалением и/или нарушением структуры сустава. Кроме того, ревматическая боль также связана с нарушениями при передаче сигналов нервной системой и психологическими проблемами больных.

На современном этапе лечение боли включает нефармакологические методы, а также использование некоторых фармакологических средств, в частности опиоидов и наркотических средств. Однако, несмотря на значительные успехи в создании препаратов, купирующих боль, в настоящее время у значительной части больных РЗ боль сохраняется и после терапии. При создании новых препаратов для лечения боли необходимо учитывать молекулярные механизмы формирования боли при РЗ. В данном обзоре рассмотрены особенности ее проявлений, молекулярные маркеры и механизмы боли на разных стадиях заболевания у больных двумя наиболее распространенными РЗ – ревматоидным артритом и остеоартритом. 

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