Concise reports
Bisphosphonate therapy of reflex sympathetic dystrophy
syndrome
a COC di Valeggio, University of Verona, Valeggio,
Verona, Italy , b Ospedale di Udine,
Italy
Correspondence to: Professor S Adami, Ospedale di Valeggio,37067 Valeggio s/M, Verona, Italy.
Accepted for publication 27 November 1996
OBJECTIVE
The reflex sympathetic dystrophy
syndrome (RSDS) is a painful limb disorder, for which a consistently
effective treatment has not yet been identified. The disease is
associated with increased bone resorption and patchy osteoporosis,
which might benefit from treatment with bisphosphonates, powerful
inhibitors of bone resorption.
METHODSTwenty patients with RSDS of foot and
hand, were randomly assigned to blind administration of either
alendronate intravenously (Istituto Gentili, Pisa, Italy) 7.5 mg
dissolved in 250 ml saline solution or placebo saline infusions daily
for three days. Two weeks later all patients had an identical treatment
course with open labelled alendronate (7.5 mg/day for three days),
independent from the results of the first blind treatment.
RESULTSIn the patients treated with blind
alendronate the diminution in spontaneous pain, tenderness, and
swelling (circumference of the affected limb) and the improvement in
motion were significantly different from baseline (p<0.001), from
those observed within the first two weeks in the control group
(p<0.01), and from week 2 to week 4 (p<0.01). In the patients given
blind placebo infusions no relevant symptomatic changes were observed
after the first two weeks of follow up, but they responded to the open
alendronate therapy given afterwards. In 12 patients with RSDS of the
hand the ultradistal bone mineral content (BMC) of the affected arm was
considerably lower than that of the controlateral arm (mean (SD))
(426(82) mg/cm versus 688(49)). Six weeks after the beginning of the
trial BMC rose by 77(12) mg/cm (p<0.001) in the affected arm, but it
did not change in the controlateral.
CONCLUSIONSThese results indicate that
bisphosphonates should be considered for the treatment of RSDS,
producing consistent and rapid remission of the disease.
© 1997 by Annals of the Rheumatic Diseases
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