The pathophysiology of Complex Regional Pain Syndrome (CRPS) is complex and still not completely understood. In addition to a convincing role of inflammation, there are a number of arguments why an involvement of the immune system has been suggested in the pathophysiology of CRPS. Therefore, some immunological aspects were further explored with the aim to achieve more insight in both the pathophysiology and possible treatment options in CRPS. The main results: 1. In contrast to what is generally assumed, inflammation may be involved in patients with cold CRPS. 2. The prevalence of antinuclear antibodies (ANA) is significantly higher in CRPS patients than in the healthy population. The prevalence of anti-neuronal antibodies however does not deviate from that in the healthy population. Striking is the fact that the prevalence of ANA was more similar to that observed in patients with an autoimmune disease such as rheumatoid arthritis than that in patients with a classic autoimmune disease. This is a relevant finding because it may affect the choice of treatment.
3. The current empirical evidence for the efficacy of administering the most commonly used immunomodulating medication (i.e. glucocorticoids, TNF-α antagonists, thalidomide, bisphosphonates, and immunoglubulins) is scarce. 4. To test the assumption that TNF-α antagonists can reduce the manifestation of inflammation in CRPS, a double-blind randomized placebo-controlled trial was conducted. Unfortunately, this study was terminated before the required number of patients for sufficient statistical power had been reached. Nevertheless, the limited data showed a trend towards a greater reduction of TNF-α in the intervention group compared with the placebo group. 5. Mast cells are known to be involved in the inflammatory process of CRPS and also play a role in the process of central sensitization. In the development of a more mechanism-based treatment of CRPS, influencing the activity of mast cells might be important.

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F.J.P.M. Huygen (Frank)
Erasmus University Rotterdam
hdl.handle.net/1765/78331
Erasmus MC: University Medical Center Rotterdam

Dirckx, M. (2015, July 3). Complex Regional Pain Syndrome: An inflammatory disease. Retrieved from http://hdl.handle.net/1765/78331