Adhesive capsulitis of shoulder and treatment with protease inhibitors in patients with human immunodeficiency virus infection: report of 8 cases.
OBJECTIVE
To describe our experience with human immunodeficiency virus (HIV) infected patients receiving protease inhibitor therapy who presented with adhesive capsulitis of the shoulder.


METHODS
Between July 1996 and December 1999, 8 HIV-infected patients (7 male) treated with protease inhibitors who presented with adhesive capsulitis of the shoulder were retrospectively identified. Diagnosis of adhesive capsulitis relied on clinical features including shoulder pain and both active and passive restricted range of motion (ROM). All available clinical and radiographic data were reviewed.


RESULTS
Onset of symptoms was insidious, and at presentation, patients complained of shoulder pain, which was bilateral in 4 of the 8 cases. Physical examination showed global restriction of active and passive ROM of the glenohumeral joint. The mean delay between initiation of HIV protease inhibitors and onset of shoulder pain was 14 months (range 2 to 36). The protease inhibitor therapy always included indinavir. No underlying condition associated with secondary adhesive capsulitis of the shoulder, including shoulder trauma, diabetes mellitus, thyroid disease, pulmonary or cardiac diseases could be identified. In all 8 patients, despite continuation of therapy with indinavir, both shoulder pain and restricted ROM completely resolved, after a mean disease course of 7.4 months.


CONCLUSIONS
Adhesive capsulitis of shoulder seems to be a new adverse event of HIV protease inhibitor therapy. In all reported cases, patients were treated with indinavir. Further observations will be necessary to confirm adhesive capsulitis as a side effect.
Grasland
A
A
Service de Médecine Interne, Hôpital Louis Mourier, Université Paris VII, Colombes, France. anne.grasland@lmr.ap-hop-paris.fr
Ziza
J M
JM
Raguin
G
G
Pouchot
J
J
Vinceneux
P
P
D000328:Adult; D002062:Bursitis / Q000139:chemically induced* / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D019469:Indinavir / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D011480:Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D016059:Range of Motion, Articular; D020127:Recovery of Function
D011480:Protease Inhibitors; D019469:Indinavir