Anti tumor Necrosis Factor - Alpha Adalimumab for Complex Regional Pain Syndrome Type 1 (CRPS-I): A Case Series
Anti tumor Necrosis Factor - Alpha Adalimumab for Complex Regional Pain Syndrome Type 1 (CRPS-I): A Case Series
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DOI：
10.1111/papr.12070
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发表时间：
2013-11-01
期刊：
影响因子：
2.6
通讯作者：
Haddad, May
中科院分区：
文献类型：
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作者：
Eisenberg, Elon;Sandler, Ifat;Haddad, May
背景和目标：有证据表明，肿瘤坏死因子-α（TNF-α）介导，至少部分，在复杂的区域疼痛综合征（CRPS）的症状和体征。在这里，我们提出了一个病例系列的患者CRPS 1型，其中抗TNF-α阿达木单抗的反应进行了assessed.Methods：10例CRPS 1型被招募。在治疗前、每两周一次皮下注射3次后1周、1个月、3个月和6个月进行评估（40 mg/0.8 mL）阿达木单抗（Humira（R）），并包括以下内容：使用0-10 cm视觉模拟量表的疼痛强度;麦吉尔疼痛问卷简表; Beck抑郁量表; SF-36问卷以及机械和热阈值（分别为Von frey毛发和热感觉分析仪）。除了个别患者的反应的描述，这两个意向治疗（ITT）和符合协议（PP）分析进行了整个group.Results：三个亚组的患者被确定为（3名患者中的每一个）：“无反应者”，“部分反应者”，和“强大的反应者”，其中改善几乎所有的参数都注意到。ITT和PP分析均表明，治疗后机械性疼痛阈值仅有改善的趋势（ITT chi（2）= 13.83，P = 0.008; PP chi（2）= 10.29，P = 0.036）。结论：这些结果表明阿达木单抗和其他可能的抗TNF-α药物可能对某些（尽管不是所有）CRPS 1型患者有用。这些初步结果沿着越来越多的证据表明TNF-α参与了CRPS的发病机制，证明了在该领域的进一步研究是合理的。
Background and aims: Evidence suggests tumor necrosis factor-alpha (TNF-alpha) mediates, at least in part, symptoms and signs in complex regional pain syndrome (CRPS). Here, we present a case series of patients with CRPS type 1, in whom the response to the anti-TNF-alpha adalimumab was assessed.Methods: Ten patients with CRPS type 1 were recruited. Assessments were performed before treatment, at 1 week, and 1, 3, and 6 months following 3 biweekly subcutaneous injections (40 mg/0.8 mL) adalimumab (Humira (R)) and included the followings: Pain intensity using a 0-10 cm visual analog scale; the Short Form of the McGill Pain Questionnaire; the Beck Depression Inventory; the SF-36 questionnaire and mechanical and thermal thresholds (Von frey hair and Thermal Sensory Analyzer, respectively). In addition to the description of individual patient responses, both intention to treat (ITT) and per-protocol (PP) analyses were performed for the entire group.Results: Three subgroups of patients were identified (3 patients in each): "nonresponders", "partial responders", and "robust responders" in whom improvement in almost all parameters was noted. Both the ITT and PP analyses demonstrated only a trend toward improvement in mechanical pain thresholds following treatment (ITT chi(2) = 13.83, P = 0.008; PP chi(2) = 10.29, P = 0.036).Conclusion: These results suggest adalimumab, and possibly other anti-TNF-alpha, can be potentially useful in some (although not in all) patients with CRPS type 1. These preliminary results along with the growing body of evidence which points to the involvement of TNF-alpha in the pathogenesis of CRPS justify further studies in this area.