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Treatment of severe, recalcitrant reflex sympathetic dystrophy: Assessment of efficacy and safety of the second generation bisphosphonate pamidronate

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Summary

The objective of the study was to assess the efficacy and the safety of pamidronate (APD) in recalcitrant reflex sympathetic dystrophy (RSD). Ten women and 13 men with a mean (± standard deviation, SD) age of 44±11 years were included. The involved sites were: the ankle (n=10), the foot (n=7), the hand (n=3), the hip (n=2), the knee (n=2) and the shoulder (n=1). Some patients had more than one site involved. Mean (± SD) duration of the disease was 15 ± 13 months. RSD was in pseudo-inflammatory phase in 16 patients and in ischaemic phase in 7 patients. RSD was post-traumatic in 17 cases; 11 patients have been previously treated unsuccessfully by sympathetic blockades. APD was administred intravenously (perfusion) to a dose of 1mg/kg/day during 3, 2 or one day. Fourteen patients received APD during 3 consecutive days whereas 7 patients have been treated during 2 consecutive days and 2 patients only during 1 day mainly due to adverse events. Efficacy was assessed by a decrease of pain=visual analogic scale (VAS, 0–100 mm) and verbal scale (PVS, range 0–3). Moreover, the patient and the observer have estimated the efficacy of the treatment on a verbal scale (EVS, range 0–3). Measurements of these parameters were performed immediately before the treatment and 7, 30, 60 and 90 days later. The maximum duration after treatment was 9 months.

A significant decrease of VAS and PVS were observed between D0 and D30 (p=0.002 and p=0.0002 respectively), D0 and D60 (p=0.0004, p=0.0004 respectively), and D0 and D90 (p=0.0003, p=0.0001 respectively). A significant increase of EVS was only observed between D0 and D90 (p=0.03). Adverse events were noted in 14 patients: transient fever (n=6), venous inflammation (n=2), transient symptomless hypocalcaemia (n=3), nausea (n=1), lymphopenia (n=1), transient hypertension (n=1). These results suggest an efficacy of APD in recalcitrant RSD. Double-blind placebo controlled studies are required to back up these preliminary results.

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Authors and Affiliations

  1. Department of Rheumatology, University of Lille, CH & U Lille, 59037, Lille cedex, France

    B. Cortet M.D., R. -M. Flipo, P. Coquerelle, B. Duquesnoy & B. Delcambre

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  1. B. Cortet M.D.
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  2. R. -M. Flipo
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  3. P. Coquerelle
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  4. B. Duquesnoy
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  5. B. Delcambre
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Cortet, B., Flipo, R.M., Coquerelle, P. et al. Treatment of severe, recalcitrant reflex sympathetic dystrophy: Assessment of efficacy and safety of the second generation bisphosphonate pamidronate. Clin Rheumatol 16, 51–56 (1997). https://doi.org/10.1007/BF02238763

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  • DOI: https://doi.org/10.1007/BF02238763

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