Clinical and radiological amelioration of refractory peripheral spondyloarthritis by pulse intravenous pamidronate therapy.
OBJECTIVE
To examine the potential therapeutic properties of an aminobisphosphonate, pamidronate, using clinical and laboratory outcome variables together with dynamic magnetic resonance imaging (MRI) and gadolinium augmentation in patients with spondyloarthropathy (SpA) refractory to nonsteroidal antiinflammatory drugs (NSAID).


METHODS
We studied 9 patients (7 male, 2 female) of mean age 27.9 years (range 19-38) and mean disease duration of 5.5 years (range 0.5-20). Five had ankylosing spondylitis (AS), 3 had undifferentiated SpA, and one had reactive arthritis. Seven were HLA-B27 positive. Two had inflammatory bowel disease. Pamidronate (60 mg) was given intravenously on Days 1, 2, 14, 28, and 56, over 4 h in 500 ml of 5% dextrose. Clinical outcome assessments included the BASDAI (disease activity), BASFI (function), BASGI (global well being) composite visual analog instruments, and swollen and tender joint count. Laboratory variables included the erthrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Dynamic MRI with gadolinium augmentation of synovium and bone was performed at baseline and at Day 84 in the first 6 patients enrolled in the study.


RESULTS
All patients completed the study and there was a significant improvement in all clinical and laboratory variables assessed. Mean swollen and tender joint count decreased by 93.8% (p = 0.017) and 98.2% (p = 0.012), respectively, and complete clinical resolution of synovitis was noted in 5 patients. BASDAI decreased by 44.2% (p = 0.028), BASFI by 47.3% (p = 0.015), and BASGI by 42.2% (p = 0.011). ESR and CRP declined by 49.4% (p = 0.012) and 66.9% (p = 0.008), respectively. Acute lymphopenia accompanied by elevated CRP levels was noted in 8 patients in the 48 h after first pamidronate infusion. Maximal rate and magnitude of enhanced MRI signal after gadolinium augmentation decreased after pamidronate therapy, especially in the bone marrow.


CONCLUSIONS
Preliminary data from uncontrolled studies support the efficacy of pamidronate therapy for NSAID refractory SpA and warrant further evaluation in controlled trials.
Maksymowych
W P
WP
Department of Medicine, University of Alberta, Edmonton, Canada.
Lambert
R
R
Jhangri
G S
GS
Leclercq
S
S
Chiu
P
P
Wong
B
B
Aaron
S
S
Russell
A S
AS
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D016918:Arthritis, Reactive / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D001799:Blood Sedimentation / Q000187:drug effects; D001853:Bone Marrow / Q000473:pathology; D002097:C-Reactive Protein / Q000032:analysis; D004164:Diphosphonates / Q000008:administration & dosage*; D004487:Edema / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005682:Gadolinium; D015796:HLA-B27 Antigen / Q000097:blood; D006801:Humans; D007275:Injections, Intravenous; D007596:Joints / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D000077268:Pamidronate; D010865:Pilot Projects; D020551:Pulse Therapy, Drug; D013167:Spondylitis, Ankylosing / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D013585:Synovitis / Q000188:drug therapy / Q000473:pathology; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D004164:Diphosphonates; D015796:HLA-B27 Antigen; D002097:C-Reactive Protein; D005682:Gadolinium; D000077268:Pamidronate