Kalita Jayantee, Shukla Ruchi, Pandey Prakash C
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
J Mol Neurosci. 2024 Dec 4;74(4):112. doi: 10.1007/s12031-024-02290-8.
The cardinal clinical features of complex regional pain syndrome type I (CRPS-I) are pain, edema, autonomic changes, and limitation of motoric movement, which may indicate the role of inflammation and cytokines. We report the effect of prednisolone on the clinical severity and mRNA profiling of proinflammatory (tumor necrosis factor (TNF)-α and interleukin (IL)-2) and anti-inflammatory cytokines (IL-10 and transforming growth factor (TGF)-β) in the patient with CRPS-I. Thirty-nine patients with CRPS-I of shoulder joint were enrolled. Their CRPS, Visual Analog Scale (VAS) and Daily Sleep Interference Scale (DSIS) scores were recorded. TNF-α, IL-2, IL-10, and TGF-β gene expressions at mRNA of whole blood were measured by reverse transcriptase polymerase chain reaction. Patients were randomized to prednisolone 20 mg or 40 mg using 1: 1 randomization. The primary outcome was change in VAS score, and secondary outcomes were change in CRPS and DSIS scores at 1 month. Side effects were noted. The patients had increased expressions of TNF-α (p < 0.001) and IL-2 (p < 0.001) and reduced IL-10 (p < 0.01) mRNA compared to the healthy controls. The baseline characteristics were matched between the two treatment arms. At 1 month, CRPS, VAS, and DSIS scores improved significantly compared to baseline, which paralleled with improvement in IL-10 (p < 0.032) and reduction in TNF-α (p = 0.046). The improvement in clinical and biomarkers was similar in prednisolone 20 mg and 40 mg arms. None had to be withdrawn due to severe side effects. Future study in larger cohort may validate these findings.
Ⅰ型复杂性区域疼痛综合征（CRPS-Ⅰ）的主要临床特征为疼痛、水肿、自主神经改变和运动受限，这可能提示炎症和细胞因子的作用。我们报告了泼尼松龙对CRPS-Ⅰ患者临床严重程度以及促炎细胞因子（肿瘤坏死因子（TNF）-α和白细胞介素（IL）-2）和抗炎细胞因子（IL-10和转化生长因子（TGF）-β）mRNA谱的影响。纳入了39例肩关节CRPS-Ⅰ患者。记录他们的CRPS、视觉模拟评分（VAS）和每日睡眠干扰量表（DSIS）评分。通过逆转录聚合酶链反应测量全血mRNA水平的TNF-α、IL-2、IL-10和TGF-β基因表达。患者按1:1随机分为20 mg或40 mg泼尼松龙组。主要结局为VAS评分的变化，次要结局为1个月时CRPS和DSIS评分的变化。记录副作用。与健康对照相比，患者TNF-α（p＜0.001）和IL-2（p＜0.001）的mRNA表达增加，IL-10（p＜0.01）的mRNA表达降低。两个治疗组的基线特征相匹配。1个月时，与基线相比，CRPS、VAS和DSIS评分显著改善，这与IL-10的改善（p＜0.032）和TNF-α的降低（p = 0.046）平行。20 mg和40 mg泼尼松龙组的临床和生物标志物改善相似。无人因严重副作用而退出研究。未来更大队列的研究可能会验证这些发现。
