Клиническое значение фибромиалгии при ревматических заболеваниях: особенности диагностики и терапевтические стратегии

По данным Всемирной организации здравоохранения, боль остаётся одной из ведущих причин обращения за медицинской помощью. Современное понимание боли базируется на биопсихосоциальной модели. Хронический болевой синдром (ХБС) у больных с ревматическими заболеваниями представляет собой сложный многоуровневый континуум, часто смешанный по происхождению, в котором сочетаются ноцицептивные, нейропатические и ноципластические механизмы. В обзоре анализируется место центральной сенситизации (ЦС) и фибромиалгии (ФМ) в поддержании персистирования боли у пациентов ревматологического профиля, представлены данные систематических обзоров и мета-анализов о распространённости ФМ при различных ревматических заболеваниях и её влиянии на клинические индексы активности заболевания и качество жизни пациентов. Обсуждаются современные терапевтические подходы к коррекции ЦС и ФМ, включая немедикаментозные методы, препараты центрального действия и перспективы применения ингибиторов янус-киназ (JAK), способных воздействовать как на воспалительные, так и на нейроиммунные механизмы боли.

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