title: Puffy hand syndrome due to drug addiction: a case-control study of the pathogenesis.
abstract: OBJECTIVE
  We studied the pathogenesis of puffy hand syndrome of intravenous drug use. We hypothesized that injections of high-dose sublingual buprenorphine, instead of the recommended sublingual administration, could play an important role in lymphatic obstruction and destruction.
  
  
  METHODS
  We set up a case-control study in substitution centres, recruiting intravenous drug addicts with and without puffy hands, respectively. The subjects were asked to answer anonymously a questionnaire of 40 items comprising social and demographic status, history of illicit drugs use, buprenorphine misuse and injection practices.
  
  
  RESULTS
  We included 33 cases and 33 controls, mean age of 34 years. They were past heroin users, mainly methadone-substituted. In multivariate analysis, sex (women) (OR = 8.9, P = 0.03), injections in the hands (OR = 5.9, P = 0.03), injections in the feet (OR = 6.5, P = 0.01) and the absence of tourniquet (OR = 7.0, p = 0.02) were significant risk factors for puffy hand syndrome. In 69.7% of the cases and 59.4% of the controls, respectively, there was a high-dose sublingual buprenorphine misuse, although it appeared not to be a significant risk factor for puffy hand syndrome.
  
  
  CONCLUSIONS
  Injection practices are likely to cause puffy hands syndrome, but buprenorphine misuse should not be considered as a significant risk factor. However, intravenous drug users must still be warned of local and systemic complications of intravenous drug misuse.
authors.affiliation: Hypertension Maladies vasculaires Pharmacologie clinique, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg cedex, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Andresz
authors.forename: Nicolas
authors.initials: N
authors.lastname: Marcantoni
authors.forename: Florence
authors.initials: F
authors.lastname: Binder
authors.forename: Michel
authors.initials: M
authors.lastname: Velten
authors.forename: Martine
authors.initials: M
authors.lastname: Alt
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Weber
authors.forename: Dominique
authors.initials: D
authors.lastname: Stephan
mesh_terms: D002047:Buprenorphine / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D005602:France; D006225:Hand; D006801:Humans; D008209:Lymphedema / Q000139:chemically induced*; D008297:Male; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013577:Syndrome
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine