为什么会出现乏力/疲劳?类风湿性关节炎的潜在治疗机制和相关性。

IF 3.9 3区 医学 Q2 IMMUNOLOGY
Expert Review of Clinical Immunology Pub Date : 2024-05-01 Epub Date: 2024-01-19 DOI:10.1080/1744666X.2024.2306220
Yoshiya Tanaka, Kei Ikeda, Yuko Kaneko, Naoki Ishiguro, Tsutomu Takeuchi
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引用次数: 0

摘要

导言:疲劳和不适通常与包括类风湿性关节炎(RA)在内的多种疾病相关。有证据表明,疲劳和乏力可能会让患者难以承受,但这些症状仍未得到充分控制,这主要是由于对其根本原因的解释不全面:在对已发表的有关慢性病疲劳或乏力发病机理的文献进行评估时,确定了四个关键的机理主题。对每个主题(炎症、下丘脑-垂体-肾上腺轴、自律神经失调和单胺类)以及各主题之间复杂的相互联系网络进行了讨论,这些网络表明炎症细胞因子在疲劳的发生和持续过程中发挥着关键作用:疲劳是多方面的,定义不清,理解不完善。此外,疲劳的原因和严重程度可能会随着自然病程或药物治疗的结果而改变。通过对现有证据的详细综述,我们可以确定当前治疗优化和未来研究的途径,以改善对RA患者疲劳和不适的管理。我们预计,未来五年将在减轻RA患者的疲劳症状方面取得亟需的进展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Why does malaise/fatigue occur? Underlying mechanisms and potential relevance to treatments in rheumatoid arthritis.

Introduction: Fatigue and malaise are commonly associated with a wide range of medical conditions, including rheumatoid arthritis (RA). Evidence suggests that fatigue and malaise can be overwhelming for patients, yet these symptoms remain inadequately-managed, largely due to an incomplete elucidation of the underlying causes.

Areas covered: In this assessment of the published literature relating to the pathogenesis of fatigue or malaise in chronic conditions, four key mechanistic themes were identified. Each theme (inflammation, hypothalamic-pituitary-adrenal axis, dysautonomia, and monoamines) is discussed, as well as the complex network of interconnections between themes which suggests a key role for inflammatory cytokines in the development and persistence of fatigue.

Expert opinion: Fatigue is multifaceted, poorly defined, and imperfectly comprehended. Moreover, the cause and severity of fatigue may change over time, as a consequence of the natural disease course or pharmacologic treatment. This detailed synthesis of available evidence permits us to identify avenues for current treatment optimization and future research, to improve the management of fatigue and malaise in RA. Within the development pipeline, several new anti-inflammatory therapies are currently under investigation, and we anticipate that the next five years will herald much-needed progress to reduce the debilitating nature of fatigue in patients with RA.

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来源期刊
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.
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