Concept and limits of the reflex sympathetic dystrophy

Abstract

Reflex sympathetic dystrophy (RSD) is a clinical syndrome defined in the English literature by pain, dystrophic tissue changes and local disturbance of autonomic function in a limb or part of a limb. Algodystrophy is the common name used for the condition in the French literature, in which the concept also includes the "transient regional osteoporosis" and the "regional migratory osteolysis". We want to discuss three points: 1) Are the RSD, transient regional osteoporosis and migratory osteolysis different diseases or different manifestations of a single condition? We believe that an objective differentiation is not possible between them. Our report about 28 cases of polytopic RSD shows the frequent association in the same patient of these manifestations and we believe that this represents the broad spectrum of a single disease. 2) Is the accepted classic pathophysiologic mechanism of RSD accurate? The conception of a disturbance of autonomic function is not easily linked with its association with conditions such as diabetes, hyperthyroidism, hyperlipidaemia and others. Even more difficult to explain is the association with malignancy and osteomalacia. The deposit of immunoglobulins that we have demonstrated in two cases in the palmar fascia of RSD associated with malignancy suggests a possible immunological mechanism. 3) What are the limits of RSD? The association between RSD and aseptic necrosis of the hip has been reported. Are they two different conditions or is the aseptic necrosis only a more developed form of RSD? Finally, we report the first single case of Munchausen syndrome mimicking a RSD of the hand with the same clinical, radiological and scintigraphic appearance.

A Case of Drug Eruption Due to Simultaneous Sensitization with Three Different Kinds of Drugs

“…The frequency of drug allergy is increasing in patients with SLE or Sjogren's syndrome (6,7), but our patient, who suffered from RSD, had no past or family history of drug allergy or such disorders. Some data suggest that an immunological mechanism is associ-ated with the pathogenesis of RSD (8). However, there are also no reports describing a relationship between the risk for adverse drug reactions and RSD.…”

Regional osteoporosis due to osteoclast activation as a trigger for the pain-like behaviors in tail-suspended mice

“…Regional osteoporosis is characterized by chronic skeletal pain and the development of localized osteoporotic changes in the periarticular bone. These clinical and radiological features are found in conditions associated with chronic skeletal disease with refractory limb pain such as transient osteoporosis of the hip, regional migratory osteoporosis, or complex regional pain syndrome (CRPS) . Transient osteoporosis of the hip is a rare self‐limiting condition that involves the acute onset of hip pain and diffuse osteoporotic changes in the femoral head and neck without a history of major trauma .…”

“…Regional migratory osteoporosis presents as an idiopathic migrating arthralgia of the weight‐bearing joints of the lower limbs associated with severe focal osteoporosis at the involved site, which was reported to share the same disease process as transient osteoporosis of the hip . CRPS, also known as reflex sympathetic dystrophy, usually develops after trauma and immobilization, and is characterized by focal pain, hyperalgesia, autonomic disturbance, and bone osteoporotic changes such as regional osteoporosis . These diseases may have a common pathogenesis and could respond to similar treatment with regard to acute local osteoporotic changes, although their etiology remains uncertain.…”