TNF-α in CRPS and 'normal' trauma--significant differences between tissue and serum.
Posttraumatic TNF-alpha signaling may be one of the factors responsible for pain and hyperalgesia in complex regional pain syndromes (CRPS). In order to further specify the role of TNF-alpha we investigated tissue (skin) and serum concentrations in three different patient groups: patients with osteoarthritis and planned surgery, with acute traumatic upper limb bone fracture waiting for surgery, and with CRPS I. Thirty patients (10 in each group) were recruited. Mean CRPS duration was 36.1 ± 8.1 weeks (range 8- 90 weeks). Skin punch biopsies were taken at the beginning of the surgery in osteoarthritis and fracture patients and from the affected side in CRPS patients. Blood samples were taken before the respective procedures. Skin and serum TNF-alpha levels were quantified by ELISA. Compared to patients with osteoarthritis, skin TNF-alpha was significantly elevated in CRPS (p<0.001) and fracture patients (p<0.04). Skin TNF-alpha in CRPS patients was higher than in patients with acute bone fracture (p<0.02). In contrast, serum TNF-alpha values were the same in osteoarthritis and CRPS, and lower in fracture patients (p<0.03). Our results indicate a local but not systemic increase of TNF-alpha in CRPS patients. This increase persists for months after limb trauma and may offer the opportunity for targeted treatment.
Department of Neurology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany Department of Trauma Surgery and Orthopedics, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany Department of Neurology, University of Würzburg, Germany.
Heidrun H
HH
Krämer
Tatiana
T
Eberle
Nurcan
N
Üçeyler
Ina
I
Wagner
Thomas
T
Klonschinsky
Lars P
LP
Müller
Claudia
C
Sommer
Frank
F
Birklein
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020918:Complex Regional Pain Syndromes / Q000097:blood* / Q000175:diagnosis / Q000473:pathology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D050723:Fractures, Bone / Q000097:blood / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000097:blood / Q000473:pathology; D010865:Pilot Projects; D012867:Skin / Q000378:metabolism / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis / Q000097:blood*; D015854:Up-Regulation / Q000502:physiology; D014947:Wounds and Injuries / Q000097:blood* / Q000175:diagnosis / Q000473:pathology
D014409:Tumor Necrosis Factor-alpha