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Nat Rev Rheumatol. 2017 Jul;13(7):410-420. doi: 10.1038/nrrheum.2017.92. Epub 2017 Jun 15.

Pain in ankylosing spondylitis: a neuro-immune collaboration.

Bidad K1,2, Gracey E1,3, Hemington KS1,4,5, Mapplebeck JCS5,6,7, Davis KD1,4,5,8, Inman RD1,3,4.

Author information

1
Krembil Research Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
2
Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, 62 Dr Gharib Street, Keshavarz Boulevard, Tehran 14194, Iran.
3
Department of Immunology, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.
4
Institute of Medical Science, Medical Sciences Building, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.
5
University of Toronto Centre for the Study of Pain, 155 College Street, Toronto, Ontario M5T 1P8, Canada.
6
Department of Physiology, Medical Sciences Building, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.
7
The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
8
Department of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada.

Abstract

Clinicians have commonly differentiated chronic back pain into two broad subsets: namely, non-inflammatory (or mechanical) back pain and inflammatory back pain. As the terminology suggests, the latter category, in which ankylosing spondylitis (AS) is prominent, presupposes a close link between pain and inflammation. Advances in research into the genetics and immunology of AS have improved our understanding of the inflammatory processes involved in this disease, and have led to the development of potent anti-inflammatory biologic therapeutic agents. However, evidence from clinical trials and from biomarker and imaging studies in patients with AS indicate that pain and inflammation are not always correlated. Thus, the assumption that pain in AS is a reliable surrogate marker for inflammation might be an over-simplification. This Review provides an overview of current concepts relating to neuro-immune interactions in AS and summarizes research that reveals an increasingly complex interplay between the activation of the immune system and pain pathways in the nervous system. The different types of pain experienced by patients with AS, insights from brain imaging studies, neurological mechanisms of pain, sex bias in pain and how the immune system can modify pain in patients with AS are also discussed.

PMID:
28615730
DOI:
10.1038/nrrheum.2017.92
[Indexed for MEDLINE]

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