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Year : 2010  |  Volume : 5  |  Issue : 4  |  Page : 171-175

Pulse Pamidronate therapy in NSAID refractory ankylosing spondylitis. Is it effective?-An open label study

Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Correspondence Address:
Skand Shukla
Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
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Source of Support: None, Conflict of Interest: None

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Objective: To assess the efficacy of pulse Pamidronate therapy in NSAID refractory ankylosing spondylitis (AS). Patients: Fifty two patients of ankylosing spondylitis (fulfilling modified New York criteria), refractory to NSAID and having active disease were enrolled. Active disease was defined as BASDAI ≥ 4 and/or early morning stiffness ≥ 45 minutes despite NSAID therapy. Intervention: Monthly intravenous Pamidronate infusions (60 mg) for a period of 6 months along with current NSAID. Primary outcome measure was improvement in BASDAI at the end of therapy. Secondary outcome mea- sures included improvement in BASDAI ≥ 25%, BASFI, metrology parameters, visual analogue scales for pain and global assessment of disease, ESR, CRP, MMP-3 and quality of life domains. Results: Out of 52 patients enrolled [47 men; mean age 36.2 years (range 22-53 years) and mean disease duration 7.2 years (3-25 years)], 47 patients completed the study. At 6 months, there were significant improvement in BAS- DAI (P < 0.005), BASFI (P < 0.005), pain (P < 0.005) and patient global assessment of disease (P < 0.005) and lateral flexion (P < 0.05). However, BASDAI ≥ 25% reduction was seen in 29.6% patients only. In addition, quality of life, HAQ and serological markers MMP-3, ESR and CRP were not significantly altered. Most common adverse effects included arthralgias and myalgias, 22.5% each, following initial infusions. There were five withdrawals; two defaults and one for hip joint replacement and two for asymptomatic rise in serum creatinine. Conclusion: Pamidronate has modest efficacy in improving the patient reported outcome variables in NSAID refractory AS.

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