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Innervation of the joint and role of neuropeptides.
- Konttinen YT, Tiainen VM, Gomez-Barrena E, Hukkanen M, Salo J
Ann N Y Acad Sci. 2006 Jun;1069:149-54.
Rheumatoid arthritis
is considered to represent a disease of the synovial membrane,
osteoarthritis
of the hyaline
articular
cartilage,
and osteoporosis
of the bone. It can be questioned to what extent this is true and to what extent these diseases could be considered to be due to extra-articular, extra-skeletal pathology
related to the neuroendocrine system. Pain is the main symptom
in arthritis.
This is related to prostaglandin-mediated sensitization of the primary afferent
nociceptive
nerves. Accordingly, nonsteroidal anti-inflammatory
drugs are used in symptomatic
treatment, occasionally together with opioids and tricyclic
antidepressants. The midline
symmetry and involvement of the richly innervated, small peripheral
joints in rheumatoid arthritis
have raised speculation about the role
of neurogenic
inflammation and neuropeptides
in its pathogenesis.
In contrast to the free nerve endings,
the role
of the proprioceptive sensors is to provide information of our actual motor performance (the afferent
copy of our movements) compared to the efferent
motor program, which is activated by our will to move. These include proprioceptors in the skin (e.g., Meissner corpuscles), muscles (annulospiral and flower-spray endings of the muscle spindles),
Golgi tendon
organs, and Ruffini end organs and Pacinian corpuscles
in the superficial and deep layers of the joint capsule.
Elderly people may have slow reflexes, lax
joints, joint incongruity, and loss of muscle power; obesity,
alcohol
and medicinal use, and joint pain can be combined with poor/nonexisting capacity for repair
and remodeling of the musculoskeletal tissues. Impaired biomechanics
contributes to increased joint tenderness, accumulation of minor
trauma
(secondary osteoarthritis),
and falls (osteoporotic fractures).
More attention needs
to be paid to aging
of proprioception,
not only to the terminal disease target.
This abstract at PubMed.