Salesi Mansour, Mottaghi Peyman, Karimifar Mansour, Farajzadegan Ziba
Assistant Professor, Department of Rheumatology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Med Sci. 2012 May;17(5):422-7.
Patients with rheumatoid arthritis may be resistant to conventional treatment with disease-modifying antirheumatic drugs (DMARDs). On the other hand, biologic therapy is costly and may be inconvenient for many patients. Pamidronate is a potent bisphosphonate with the capacity of modifying the biological activity of the immune system cells. It may thus be used as an anti-inflammatory agent in patients with inflammatory joint diseases.
To assess the effectiveness of pamidronate in the management of rheumatoid arthritis, we selected 38 patients with rheumatoid arthritis to enroll in a pilot study to receive pamidronate and conventional treatment with prednisolone and DMARDs in combination. These patients received 60 mg of pamidronate for 3 consecutive months and were followed for 6 months since the first infusion.
The mean visual analogue score (VAS) and disease activity score (DAS28) fell steadily until one month after the third infusion. However, no improvements were observed during the 3 months after the last infusion of the drug. All patients, except one, reported decreased pain in response to 3 consecutive pulses of pamidronate and most had improvements in the assessed laboratory and clinical indices. The drug was tolerated well in our patients.
Pamidronate infusions had beneficial effects on various clinical and laboratory parameters of patients, but alleviation of symptoms were temporary and did not last for more than 6 months. This treatment option can be a choice for difficult cases of rheumatoid arthritis with severe pain and osteoporosis.
类风湿关节炎患者可能对使用改善病情抗风湿药（DMARDs）的传统治疗产生耐药性。另一方面，生物疗法成本高昂，且对许多患者来说可能不太方便。帕米膦酸盐是一种强效双膦酸盐，具有调节免疫系统细胞生物活性的能力。因此，它可作为炎性关节疾病患者的抗炎药物。
为评估帕米膦酸盐治疗类风湿关节炎的有效性，我们选择了38例类风湿关节炎患者参加一项试点研究，接受帕米膦酸盐与泼尼松龙和DMARDs联合的传统治疗。这些患者连续3个月接受60mg帕米膦酸盐治疗，并自首次输注起随访6个月。
平均视觉模拟评分（VAS）和疾病活动评分（DAS28）在第三次输注后1个月时持续下降。然而，在最后一次输注药物后的3个月内未观察到改善。除1例患者外，所有患者均报告在连续3次输注帕米膦酸盐后疼痛减轻，且大多数患者的评估实验室和临床指标有所改善。我们的患者对该药物耐受性良好。
帕米膦酸盐输注对患者的各种临床和实验室参数有有益影响，但症状缓解是暂时的，持续时间不超过6个月。这种治疗选择可作为类风湿关节炎伴严重疼痛和骨质疏松症的疑难病例的一种选择。
