JAK/STAT pathway and nociceptive cytokine signalling in rheumatoid arthritis and psoriatic arthritis. 2021

Natascia Crispino, and Francesco Ciccia
Medical Department, Pfizer Italy, Rome, Italy.

The key role of pro-inflammatory cytokines in the pathogenesis of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) is strongly supported by the observation that their blockage is effective in the treatment of these diseases. Indeed, blockade of cytokine signal transduction mechanisms, including the JAK-STAT pathway, may be critical in the treatment of RA and PsA. The Janus kinase (JAK) inhibitors tofacitinib and baricitinib target JAKs with high potency and have a well-established rationale for clinical therapeutic use in RA and PsA by affecting multiple cytokines involved in both development and propagation of the disease. Nociceptive responses are also important to consider in the treatment RA and PsA. In this regard, cytokines have also been implicated in modulation of pain and nociception and the JAK/STAT pathway is receiving increasing attention in modulation of nociceptive responses given to its clear role in cytokine signalling. Therefore, inhibition of JAK/STAT pathway with specific JAK inhibitors has the potential to modulate pain in patients with RA and PsA. Data from randomised controlled trials and real-world settings on large numbers of patients with RA (tofacitinib and baricitinib) and randomised controlled trials in patients with PsA (tofacitinib) have shown that a rapid effect on the pain component in these diseases is observed. Thus, it can be hypothesised that JAK inhibitors may have a dual therapeutic role by modulating inflammation and nociception, which leads to clinical benefits including reduction of pain beyond that related to inflammation. The present review will overview the impact of pain in patients with rheumatic disease and the physiological basis of modulating nociceptive pain. Current knowledge about the role of cytokines in mediation of pain and the involvement of the JAK/STAT pathway in modulating nociceptive responses will then be summarised, followed by an analysis of clinical data on pain modulation by JAK inhibitors in the treatment of RA and PsA.

UI MeSH Term Description Entries
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001172 Arthritis, Rheumatoid A chronic systemic disease, primarily of the joints, marked by inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures. Etiology is unknown, but autoimmune mechanisms have been implicated. Rheumatoid Arthritis
D015535 Arthritis, Psoriatic A type of inflammatory arthritis associated with PSORIASIS, often involving the axial joints and the peripheral terminal interphalangeal joints. It is characterized by the presence of HLA-B27-associated SPONDYLARTHROPATHY, and the absence of rheumatoid factor. Psoriasis Arthropathica,Psoriasis, Arthritic,Psoriatic Arthritis,Psoriatic Arthropathy,Arthritic Psoriasis,Arthropathies, Psoriatic,Arthropathy, Psoriatic,Psoriatic Arthropathies
D016207 Cytokines Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. Cytokine
D053612 Janus Kinases A family of intracellular tyrosine kinases that participate in the signaling cascade of cytokines by associating with specific CYTOKINE RECEPTORS. They act upon STAT TRANSCRIPTION FACTORS in signaling pathway referred to as the JAK/STAT pathway. The name Janus kinase refers to the fact the proteins have two phosphate-transferring domains. Janus Kinase,JAK Kinases,Kinase, Janus,Kinases, JAK,Kinases, Janus
D059225 Nociception Sensing of noxious mechanical, thermal or chemical stimuli by NOCICEPTORS. It is the sensory component of visceral and tissue pain (NOCICEPTIVE PAIN). Nociperception,Nociceptions,Nociperceptions

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