title: Assessment of the efficacy of pamidronate in ankylosing spondylitis: an open prospective trial.
abstract: BACKGROUND
  Bisphosphonates have anti-inflammatory properties in arthritic conditions. This study was conducted to assess the therapeutic potential of intravenous pamidronate in nonsteroidal anti-inflammatory drug (NSAID) refractory/intolerant cases of ankylosing spondylitis (AS).
  
  
  METHODS
  A total of 35 NSAID refractory/intolerant AS patients with Bath AS Disease Activity Index (BASDAI) score 4 or above were recruited for the study. Monthly pamidronate infusions (60 mg) were administered to the patients for six months. Treatment outcomes were assessed by comparing baseline values with the values after six infusions using BASDAI, Bath AS Functional Index (BASFI), Metrology Index (BASMI) and Global Score (BAS-G), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). An improvement was defined according to the Assessments in Ankylosing Spondylitis (ASAS)-20 and BASDAI-50.
  
  
  RESULTS
  26 patients received all the six infusions. Of these, 22 (85 percent) achieved ASAS-20 and 20 (77 percent) achieved BASDAI-50 responses. Decrements were noted in the mean BASDAI (56.4 percent), BASFI (52.66 percent), BASMI (55.72 percent), BAS-G (66.71 percent), ESR (52.12 percent) and CRP (72.84 percent) after six months. The tender and swollen joint counts of 14 (54 percent) patients with peripheral arthritis were respectively reduced to a mean value of 0.85 and nil, from the baseline of 2.57 and 1.2. Early feel good response was noted in 16 (62 percent) patients within 48 hours of the first infusion. Fever, arthralgia and myalgia were observed in six cases after the first infusion, and in one case, after the second infusion. These symptoms resolved spontaneously within 24 hours.
  
  
  CONCLUSIONS
  Intravenous pamidronate has good efficacy for the treatment of AS.
authors.affiliation: Department of Medicine, Medical College, Kolkata, West Bengal 700073, India. g.santra@yahoo.com
authors.forename: G
authors.initials: G
authors.lastname: Santra
authors.forename: R N
authors.initials: RN
authors.lastname: Sarkar
authors.forename: S
authors.initials: S
authors.lastname: Phaujdar
authors.forename: S
authors.initials: S
authors.lastname: Banerjee
authors.forename: S
authors.initials: S
authors.lastname: Siddhanta
mesh_terms: D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001799:Blood Sedimentation / Q000187:drug effects; D002097:C-Reactive Protein / Q000187:drug effects; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use; D004008:Diclofenac / Q000627:therapeutic use; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D017308:Etodolac / Q000627:therapeutic use; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D008297:Male; D000077268:Pamidronate; D011446:Prospective Studies; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D004164:Diphosphonates; D014409:Tumor Necrosis Factor-alpha; D004008:Diclofenac; D017308:Etodolac; D002097:C-Reactive Protein; D000077268:Pamidronate; D007213:Indomethacin