Pain in spondyloarthritis: A neuro-immune interaction

Ejaz M I Pathan; Robert D Inman

doi:10.1016/j.berh.2018.07.003

Pain in spondyloarthritis: A neuro-immune interaction

Best Pract Res Clin Rheumatol. 2017 Dec;31(6):830-845. doi: 10.1016/j.berh.2018.07.003. Epub 2018 Aug 17.

Authors

Ejaz M I Pathan¹, Robert D Inman²

Affiliations

¹ Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada. Electronic address: ejaz.pathan@mail.utoronto.ca.
² Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada; Krembil Research Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada; Department of Immunology, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada; Institute of Medical Science, Medical Sciences Building, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.

PMID: 30509443
DOI: 10.1016/j.berh.2018.07.003

Abstract

Pain in spondyloarthritis is usually attributed to inflammation. However, treatment with potent biologic agents that control inflammation does not always control the pain. Pain is hence likely to be multifactorial. Fatigue is another prominent feature of this condition which again tends to respond poorly to potent biologic agents. There is also a growing interest in coexisting fibromyalgia in this group of patients and how this affects response to biologic therapies. Advances in neuroimaging have helped in better understanding the dynamic nature of brain networks in the perception of pain. Animal models have helped in developing concepts of peripheral and central sensitization in pain transmission. This review discusses the neuroimmune basis of pain in ankylosing spondylitis, with an emphasis on brain networks and the complex interactions between the nervous system and the immune system at various levels. It also provides some insights into the differences in pain perception between men and women.

Keywords: Brain networks; Fatigue; Fibromyalgia; Neuroimmune interface; Pain; Spondyloarthritis.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Animals
Central Nervous System Sensitization / physiology
Female
Humans
Male
Neuroimmunomodulation / physiology*
Pain / etiology*
Pain Perception / physiology*
Spondylarthritis / complications*