Bisphosphonate-associated arthritis.
We present a case of arthritis apparently induced by the administration of intravenous bisphosphonates in a 51-year-old white woman with metastatic breast carcinoma. She presented with bilateral knee pain and effusions on 2 separate occasions after receiving aminobisphosphonates. Synovial fluid analysis was negative for infection, metastasis, or crystals. Her symptoms resolved after the medication was discontinued and recurred after the patient was rechallenged with a medication from the same drug class. The administration of aminobisphosphonates has been associated with an acute-phase response in several in vivo studies. The mechanism of action is thought to be that aminobisphosphonates transiently stimulate the production of proinflammatory cytokines such as interleukin-1, interleukin-6, and tumor necrosis factor-alpha. Rheumatologists should be aware of this possible cause of arthropathy.
Diaz-Borjon
Alejandro
A
Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia 30303, USA. adiazbo@emory.edu
Seyler
Thorsten M
TM
Chen
Natasha L
NL
Lim
S Sam
SS
D001168:Arthritis / Q000139:chemically induced*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy; D004164:Diphosphonates / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy; D007093:Imidazoles / Q000009:adverse effects*; D007262:Infusions, Intravenous; D008875:Middle Aged; D000077268:Pamidronate; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077268:Pamidronate