Abstract
Pamidronate, along with other bisphosphonates, has been used for treatment of bone pain secondary to malignant involvement or metastatic disease for years. Some data, however, have also accumulated on the utility of pamidronate in a variety of benign conditions frequently handled by rheumatologists. This study aims to review the available published data regarding the potential use of pamidronate in rheumatology practice. Methods include the review of relevant articles retrieved by a PUBMED search utilizing the index term “pamidronate”. All available randomized control trials, open trials, and case series, as well as properly reported case studies evaluating usage of pamidronate in rheumatic disorders, have been included in the literature review. The efficacy of pamidronate in patients with spondyloarthropathies; synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome; hypertrophic osteoarthropathy; osteoporotic vertebral fractures; chronic back pain due to disk disease or spinal stenosis; Charcot arthropathy; transient osteoporosis; and complex regional pain syndrome-I, has been demonstrated in more than 40 reports, the majority of which, however, were not controlled studies. In some of reviewed conditions, aside from providing analgesic relief, pamidronate may also have disease-modifying properties. While used in different doses in a variety of rheumatic disorders, pamidronate was generally reported to be well tolerated with an overall good safety profile. Pamidronate may represent an effective and safe choice for a spectrum of rheumatic patients, suffering from intractable musculoskeletal pain, unresponsive to traditionally recommended therapies. Large randomized, controlled studies examining the efficacy of pamidronate in the rheumatic conditions are urgently needed.
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References
Maksymowych WP, Jhangri GS, Fitzgerald AA, LeClercq S, Chiu P, Yan A et al (2002) A six-months randomized, controlled, double-blind, dose-response comparison of intravenous pamidronate (60 mg versus 10 mg) in the treatment of nonsteroidal anti-inflammatory drug-refractory ankylosing spondylitis. Arthritis Rheum 46:766–773
Maksymowych WP, Jhangri GS, LeClercq S, Skeith K, Yan A, Russell AS (1998) An open study of pamidronate in the treatment of refractory ankylosing spondylitis. J Rheumatol 25:714–717
Maksymowych WP, Lambert R, Jhangri GS, LeClercq S, Chiu P, Wong B et al (2001) Clinical and radiological amelioration of refractory peripheral spondyloarthritis by pulse intravenous pamidronate therapy. J Rheumatol 28:144–155
Haibel H, Brandt J, Rudwaleit M, Soerensen H, Sieper J, Braun J (2003) Treatment of active ankylosing spondylitis with pamidronate. Rheumatology 42:1018–1020
Cairns AP, Wright SA, Taggart AJ, Coward SM, Wright GD (2005) An open study of pulse pamidronate treatment in severe ankylosing spondylitis, and its effect on biochemical markers of bone turnover. Ann Rheum Dis 64:338–339
Grover R, Shankar S, Aneja R, Marwaha V, Gupta R, Kumar A (2006) Treatment of ankylosing spondylitis with pamidronate: an open label study. Ann Rheum Dis 65:688–689
Toussirot E, Le Huede G, Lohse A, Cedos J-P, Wendling D (2006) Transient efficacy of pulse pamidronate treatment in active spondyloarthropathies: an open study of 35 cases. Clin Exp Rheumatol 24:348
Maksymowych WP, Aaron S, Russell AS (2001) Treatment of refractory symphysitis pubis with intravenous pamidronate. J Rheumatol 28:2754–2757
Marshall H, Bromilow J, Thomas AL, Arden NK (2002) Pamidronate: a novel treatment for the SAPHO syndrome? Rheumatology 41:231–233
Courtney PA, Hosking DJ, Fairbairn KJ, Deighton CM (2002) Treatment of SAPHO with pamidronate. Rheumatology 41:1196–1198
Guignard S, Job-Deslandre C, Sayag-Boukris V, Kahan A (2002) Pamidronate treatment in SAPHO syndrome. Joint Bone Spine 69:392–396
Amital H, Applbaum YH, Aamar S, Daniel N, Rubinow A (2004) SAPHO syndrome treated with pamidronate: an open-label study of 10 patients. Rheumatology 43:658–661
Valls-Roc M, Sanmarti M, Salles M, Holgado S, Olive A (2005) SAPHO syndrome and pamidronate revisited. Rheumatology 44:137
Tehrani R (2005) SAPHO syndrome treated with pamidronate. Indian J Dermatol Venereol Leprol 71:273–275
Solau-Gervais E, Soubrier M, Gerot I, Grange L, Puechal X, Sordet C et al (2006) The usefulness of bone remodeling markers in predicting the efficacy of pamidronate treatment in SAPHO syndrome. Rheumatology 45:339–342
Kerrison C, Davidson JE, Cleary AG, Beresford MW (2004) Pamidronate in the treatment of childhood SAPHO syndrome. Rheumatology 34:1246–1251
Simm PJ, Allen RC, Zacharin MR (2008) Bisphosphonate treatment in chronic recurrent multifocal osteomyelitis. J Pediatr 152:571–575
Gleeson H, Wiltshire E, Briody J, Hall J, Chaitow J, Sillence D et al (2008) Childhood chronic recurrent multifocal osteomyelitis: pamidronate therapy decreases pain and improves vertebral shape. J Rheumatol 35:707–712
Guyot-Drouot M-H, Solau-Gervais E, Cortet B, Deprez X, Chastanet P, Cotten A et al (2000) Rheumatologic manifestations of pachydermoperiostosis and preliminary experience with bisphosphonates. J Rheumatol 27:2418–2423
Bhansali A, Singh R, Sriraam M, Bhadada S (2006) Pachydermoperiostitis and bisphosphonates. J Assoc Physicians India 54:340
Garske LA, Bell SC (2002) Pamidronate results in symptom control of hypertrophic pulmonary osteoarthropathy in cystic fibrosis. Chest 121:1363–1364
Amital H, Applbaum YH, Vasiliev L, Rubinow A (2004) Hypertrophic pulmonary osteoarthropathy: control of pain and symptoms with pamidronate. Clin Rheumatol 23:330–332
Speden D, Nicklason F, Francis H, Ward J (1997) The use of pamidronate in hypertrophic pulmonary osteoarthropathy. Aust N Z Med 27:307–310
Suzuma T, Sakurai T, Yoshimura G, Umemura T, Tamaki T, Yoshimasu T et al (2001) Pamidronate-induced remission of pain associated with hypertrophic pulmonary osteoarthropathy in chemoendocrine therapy-refractory inoperable metastatic breast carcinoma. Anticancer Drugs 12:731–734
Abdulla AJ (2000) Use of pamidronate for acute pain relief following osteoporotic vertebral fractures. Rheumatology 39:567–568
Gangji V, Appelboom T (1999) Analgesic effect of intravenous pamidronate on chronic back pain due to osteoporotic vertebral fractures. Clin Rheum 18:266–267
Armingeat T, Brondino R, Pham T, Legre V, Lafforgue P (2006) Intravenous pamidronate for pain relief in recent osteoporotic vertebral compression fracture: a randomized double-blind controlled study. Osteoporos Int 17:1659–1665
Laroche M, Cantogrel S, Jamard B, Constantin A, Zabranieski L, Cantagrel A et al (2006) Comparison of the analgesic efficacy of pamidronate and synthetic human calcitonin in osteoporotic vertebral fractures: a double-blind controlled study. Clin Rheumatol 25:683–686
Poujol D, Ristori JM, Dubost JJ, Soubrier M (2007) Efficacy of pamidronate in erosive degenerative disk disease: a pilot study. Joint Bone Spine 74:663–664
Feld J, Rosner I, Avshovich N, Boulman N, Slobodin G, Rozenbaum M (2009) An open study of pamidronate in the treatment of refractory degenerative lumbar spinal stenosis. Clin Rheum 28(6):715–717
Pappagallo M, Breuer B, Schneider A, Sperber K (2003) Treatment of chronic mechanical spinal pain with intravenous pamidronate: a review of medical records. J Pain Symptom Manage 26:678–683
Selby PL, Young MJ, Boulton AJ (1994) Bisphosphonates: a new treatment for diabetic Charcot neuroarthropathy? Diabet Med 11:28–31
Naqvi A, Cuchacovich R, Saketkoo L, Espinosa LR (2008) Acute Charcot arthropathy successfully treated with pamidronate: long-term follow-up. Am J Med Sci 335:145–148
Anderson JJ, Woelffer KE, Holtzman JJ, Jacobs AM (2004) Bisphosphonates for the treatment of Charcot neuroarthropathy. J Foot Ankle Surgery 43:285–289
Jude EB, Selby PL, Burgess J, Lilleystone P, Mawer EB, Page SR et al (2001) Bisphosphonates in the treatment og Charcot neuroarthropathy: a double-blind randomized control trial. Diabetologia 44:2032–2037
Devogelaer JP, Dall'Armellina S, Huaux JP, Nagant de Deuxchaines C (1988) Dramatic improvement of intractable reflex sympathetic dystrophy syndrome by intravenous infusions of the second generation bisphosphonate APD [abstract]. J Bone Min Res 3(Suppl):S122
Brown SC, Jeavons M, Stinson J (2005) Effectiveness of pamidronate for treating intractable chronic neuropathic pain. Case report of two adolescents. Clin J Pain 21:549–552
Maillefert JF, Chatard C, Owen S, Peere T, Tavernier C, Tebib J (1995) Treatment of refractory reflex sympathetic dystrophy with pamidronate. Ann Rheum Dis 54:687
Cortet B, Flipo R-M, Coquerelle P, Duquesnoy B, Delcambre B (1997) Treatment of severe, recalcitrant reflex sympathetic dystrophy: assessment of efficacy and safety of the second generation bisphosphonate pamidronate. Clin Rheum 16:51–56
Maillefert JF, Cortet B, Aho S (1999) Pooled results from 2 trials evaluating bisphosphonates in reflex sympathetic dystrophy. J Rheumatol 26:8
Kubalek I, Fain O, Paries J, Kettaneh A, Thomas M (2001) Treatment of reflex sympathetic dystrophy with pamidronate: 29 cases. Rheumatology 40:1394–1397
Robinson JN, Sandom J, Chapman PT (2004) Efficacy of pamidronate in complex regional pain syndrome type I. Pain Med 5:276–280
Varenna M, Zucchi F, Binelli L, Failoni S, Gallazzi M, Sinigaglia L (2002) Intravenous pamidronate in the treatment of transient osteoporosis of the hip. Bone 31:96–101
Petcu EB, Schug SA, Smith RH (2002) Clinical evaluation of onset of analgesia using intravenous pamidronate in metastatic bone pain. J Pain Symptom Manage 24:281–282
Fulfaro F, Cassucio A, Ticozzi C, Ripamonti C (1998) The role of bisphosphonates in the treatment of painful metastatic bone disease: a review of phase III trials. Pain 78:157–169
Bonabello A, Galmozzi MR, Bruzzese T, Zara GP (2001) Analgesic effect of biphosphonates in mice. Pain 91:269–275
Bonabello A, Galmozzi MR, Canaparo R, Serpe L, Zara GP (2003) Long-term analgesic effect of clodronate in rodents. Bone 33:567–574
Ceccini MG, Fleisch H (1990) Bisphosphonates in vitro specifically inhibit, among the hematopoietic series, the development of the mouth mononuclear phagocyte lineage. J Bone Miner Res 5:1019–1027
Pennanen N, Lapinjoki S, Urtti S, Monkkonen J (1995) Effect of liposomal and free biphosphonates on the IL-1β, IL-6 and TNFα secretion from RAW 264 cells in vitro. Pharmacol Res 12:916–922
Thiebaud D, Sauty A, Burckhardt P, Leuenberger P, Sitzler L, Green JR et al (1997) An in vitro and in vivo study of cytokines in the acute-phase response associated with bisphosphonates. Calcif Tissue Int 61:386–392
Van Offel JF, Schuerwegh AJ, Bridts CH, Bracke PG, Stevens WJ, De Clerck LS (2001) Influence of cyclic intravenous pamidronate on proinflammatory monocytic cytokine profiles and bone density in rheumatoid arthritis treated with low dose prednisolone and methotrexate. Clin Exp Rheumatol 19:13–20
Carbone LD, Warrington KJ, Barrow KD, Pugazhenthi M, Watsky MA, Somes G et al (2006) Pamidronate infusion in patients with systemic sclerosis results in changes in blood mononuclear cell cytokine profiles. Clin Exp Immunol 146:371–380
Kunzmann V, Bauer E, Wilhelm M (1999) Gamma/delta T-cell stimulation by pamidronate. N Engl J Med 340:737–738
Kunzmann V, Bauer E, Feurle J, Weiissinger F, Tony HP, Wilhelm M (2000) Stimulation of gamma delta T cells by aminobisphosphonates and induction of antiplasma cell activity in multiple myeloma. Blood 96:384–392
Conti L, Casetti R, Cardone M, Varano B, Martino A, Belardelli F, Poccia F, Gessani S (2005) Reciprocal activating interaction between dendritic cells and pamidronate-stimulated gammadelta T cells: role of CD86 and inflammatory cytokines. J Immunol 174:252–260
Djokanovic N, Klieger-Grossmann C, Koren G (2008) Does treatment with bisphosphonates endanger the human pregnancy? J Obstet Gynaecol Can 30:1146–1148
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Slobodin, G., Rosner, I., Feld, J. et al. Pamidronate treatment in rheumatology practice: a comprehensive review. Clin Rheumatol 28, 1359–1364 (2009). https://doi.org/10.1007/s10067-009-1256-2
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DOI: https://doi.org/10.1007/s10067-009-1256-2