Article
Treatment of bone marrow lesions of the foot and ankle in complex regional pain syndrome type I with ibandronate – a randomized trial
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Published: | October 23, 2017 |
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Objectives: Complex reginal pain syndrome type I (CRPS-I) represents a severely disabling posttraumatic pain syndrome resulting in a severe bone loss with no definitive established treatment standards. The aim of the study was to test the efficacy of intravenous ibandronate in the treatment of CRPS type I related bone lesions.
Methods: 32 patients with a CRPS-I syndrome of the foot and ankle with functional disability, showed marked bone marrow lesions on MRI. 16 patients were randomized to ibandronate infusion therapy (group 1), consisting of 3 infusions with 6mg ibandronate every three weeks. 16 patients were randomized to the control group (group 2) with pain medication consisting of ibuprofen and metamizol. All patients received physiotherapy over the study period. Patients were followed up with the a pain VAS- in mm (0-100mm) (3,6,12 and 26 weeks), the AOFAS foot and ankle score and a follow up MRI.
Results and Conclusion: Most CRPS-I cases occurred after a trauma or fracture (69%). There were 18 female and 14 male patients at an average age of 42 ( 28-64) years with a similar distribution among both groups. In the ibandronate group pain significantly decreased from 81 mm to 52mm, 34mm, 21 mm and 19 mm after 3,6,12,26 weeks (p<0.001). In the control group pain decreased from 78 mm to 71 mm, 67 mm, 58 mm to 51 mm, respectively - p<0.05. The foot and ankle score showed a significantly superior improvement in group 1 from 52(38-66) to 88 (74-100) points (p<0.001) compared to the control group - 54 (40-66) to 65 (53-77) points (p<0.05). MRI after a minimum of 3 months showed only a significant reduction of the bone marrow edema size and number of affected bones in the ibandronate group. There was no deterioration of clinical results until the 12 months follow up. Acute phase reaction rates following intravenous ibandronate in this young patient cohort are much higher than previously reported.
Intravenous ibandronate is a fast acting therapy option in the treatment of functionally disabling bone marrow lesions in CRPS type I of the foot and ankle region, showing significantly better functional and radiological results than the control group.