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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To investigate the usefulness of pamidronate in the management of active Charcot&#39;s arthropathy&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Open prospective study with a follow-up of 12 months&#44; including patients with active neuroarthropathy seen over a period of 3 years in our rheumatology unit&#46; Patients received 3 pamidronate infusions at 0&#44; 2&#44; and 4 months&#46; Clinical assessment&#44; serum&#44; and urine bone turnover markers&#44; radiological exam&#44; and scyntigraphy were performed before and after treatment&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Seven patients were included &#40;4F&#47;3M&#41;&#44; mean age&#44; 51&#46;3 years &#40;30&#8211;64&#41;&#46; The underlying disease was diabetes mellitus in 4 cases&#44; syringomyelia in 2&#44; and sensory and autonomic neuropathy in 1&#46; The joints affected were shoulder&#44; ankle&#44; tarsians&#44; metacarpophalaneal&#44; and metatarsophalangeal&#46; All patients showed a rapid resolution of clinical symptoms&#44; with a clear reduction of all bone remodeling markers that achieved statistical significance for urine NTX and urinary pyridoline &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>04 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>03&#44; respectively&#41;&#46; Six of 7 patients disclosed at the end of follow-up a radiological healing&#46; Quantitative scyntigraphy showed a clear reduction of the bone <span class="elsevierStyleSup">99</span>Tm uptake&#46; No important side affects were reported&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pamidronate appears as a useful treatment for neuroarthropathy independently of the underlying disease&#46; A rapid diagnosis and early pamidronate treatment could avoid severe articular consequences&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Investigar la utilidad del pamidronato en el tratamiento de la neuroartropat&#237;a en fase activa&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo&#44; abierto&#44; con un seguimiento de 12 meses&#46; En un per&#237;odo de 3 a&#241;os todos los pacientes con neuroartropat&#237;a activa visitados en la unidad de reumatolog&#237;a recibieron tres infusiones de pamidronato a los 0&#44; 2 y 4 meses&#46; Se realiz&#243; valoraci&#243;n cl&#237;nica&#44; de marcadores de remodelado &#243;seo en sangre y orina&#44; radiograf&#237;a simple y gammagraf&#237;a &#243;sea cuantitativa antes y despu&#233;s del tratamiento&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 7 pacientes &#40;4 varones y 3 mujeres&#41;&#44; con una media de edad de 51&#44;3 &#40;30&#8211;64&#41; a&#241;os&#46; La enfermedad de base fue diabetes mellitus en 4 casos&#44; siringomielia en 2 y neuropat&#237;a sensitiva auton&#243;mica en 1&#46; Las articulaciones afectadas fueron hombro&#44; tobillo&#44; tarsianas&#44; metatarsofal&#225;ngicas y metacarpofal&#225;ngicas&#46; Todos los pacientes mostraron una r&#225;pida resoluci&#243;n de los s&#237;ntomas&#44; con una clara reducci&#243;n de todos los marcadores de remodelado &#243;seo siendo estad&#237;sticamente significativa en el caso del NTX y piridolina en orina &#40;p <span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04 y p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#44; respectivamente&#41;&#46; Seis de los 7 pacientes mostraron una mejor&#237;a radiol&#243;gica&#46; La gammagraf&#237;a cuantitativa mostr&#243; una reducci&#243;n evidente de la captaci&#243;n&#46; No se observaron efectos adversos importantes&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El pamidronato parece un tratamiento &#250;til para la artropat&#237;a de Charcot independientemente de la enfermedad de base&#46; El diagn&#243;stico precoz y la administraci&#243;n r&#225;pida del tratamiento puede evitar complicaciones articulares graves&#46;</p>"
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Vol. 3. Issue 6.
Pages 257-261 (November - December 2007)
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Vol. 3. Issue 6.
Pages 257-261 (November - December 2007)
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Usefulness of Pamidronate in the Treatment of Charcot's Arthropathy
Utilidad del pamidronato en el tratamiento de la artropatía de Charcot
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5367
Mireia Moreno
Corresponding author
mmorenoma@cspt.es

Correspondence: Unidad de Reumatología. Hospital de Sabadell. Institut Universitari Parc Taulí (UAB). Parc Taulí, s/n. 08208 Sabadell. Barcelona. España.
, Jordi Gratacós, Enrique Casado, Carlos Galisteo, Cristóbal Orellana, Marta Larrosa
Unidad de Reumatología, Hospital de Sabadell, Institut Universitari Parc Taulí (UAB), Barcelona, Spain
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Objective

To investigate the usefulness of pamidronate in the management of active Charcot's arthropathy.

Material and methods

Open prospective study with a follow-up of 12 months, including patients with active neuroarthropathy seen over a period of 3 years in our rheumatology unit. Patients received 3 pamidronate infusions at 0, 2, and 4 months. Clinical assessment, serum, and urine bone turnover markers, radiological exam, and scyntigraphy were performed before and after treatment.

Results

Seven patients were included (4F/3M), mean age, 51.3 years (30–64). The underlying disease was diabetes mellitus in 4 cases, syringomyelia in 2, and sensory and autonomic neuropathy in 1. The joints affected were shoulder, ankle, tarsians, metacarpophalaneal, and metatarsophalangeal. All patients showed a rapid resolution of clinical symptoms, with a clear reduction of all bone remodeling markers that achieved statistical significance for urine NTX and urinary pyridoline (P=04 and P=03, respectively). Six of 7 patients disclosed at the end of follow-up a radiological healing. Quantitative scyntigraphy showed a clear reduction of the bone 99Tm uptake. No important side affects were reported.

Conclusions

Pamidronate appears as a useful treatment for neuroarthropathy independently of the underlying disease. A rapid diagnosis and early pamidronate treatment could avoid severe articular consequences.

Key words:
Charcot
Bisphosphonates
Neuroarthropathy
Pamidronato
Objetivo

Investigar la utilidad del pamidronato en el tratamiento de la neuroartropatía en fase activa.

Material y métodos

Estudio prospectivo, abierto, con un seguimiento de 12 meses. En un período de 3 años todos los pacientes con neuroartropatía activa visitados en la unidad de reumatología recibieron tres infusiones de pamidronato a los 0, 2 y 4 meses. Se realizó valoración clínica, de marcadores de remodelado óseo en sangre y orina, radiografía simple y gammagrafía ósea cuantitativa antes y después del tratamiento.

Resultados

Se incluyó a 7 pacientes (4 varones y 3 mujeres), con una media de edad de 51,3 (30–64) años. La enfermedad de base fue diabetes mellitus en 4 casos, siringomielia en 2 y neuropatía sensitiva autonómica en 1. Las articulaciones afectadas fueron hombro, tobillo, tarsianas, metatarsofalángicas y metacarpofalángicas. Todos los pacientes mostraron una rápida resolución de los síntomas, con una clara reducción de todos los marcadores de remodelado óseo siendo estadísticamente significativa en el caso del NTX y piridolina en orina (p =0,04 y p=0,03, respectivamente). Seis de los 7 pacientes mostraron una mejoría radiológica. La gammagrafía cuantitativa mostró una reducción evidente de la captación. No se observaron efectos adversos importantes.

Conclusiones

El pamidronato parece un tratamiento útil para la artropatía de Charcot independientemente de la enfermedad de base. El diagnóstico precoz y la administración rápida del tratamiento puede evitar complicaciones articulares graves.

Palabras clave:
Charcot
Bisfosfonatos
Neuroartropatía
Pamidronato
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Copyright © 2007. Sociedad Española de Reumatología and Colegio Mexicano de Reumatología
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