Bone Pain in Transplant Recipients Responsive to Calcium Channel Blockers (1994)

Brief Communications1 December 1994Bone Pain in Transplant Recipients Responsive to Calcium Channel BlockersV. Joyce Gauthier, MD, PhD and Leyka M. Barbosa, MDV. Joyce Gauthier, MD, PhDFrom the University of Washington, Seattle, Washington. and Leyka M. Barbosa, MDFrom the University of Washington, Seattle, Washington.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-121-11-199412010-00007 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Bouteiller and colleagues [1] and Lucas and colleagues [2] have reported a bone pain syndrome in the epiphyseal regions of 17% of patients who received renal transplantation. This syndrome occurred only in patients receiving cyclosporine in addition to corticosteroids and not in patients treated only with azathioprine and prednisone alone [2, 3]. The episodes of pain were temporally related to increased cyclosporine levels, were relieved when the dose was decreased, and returned with rechallenge [1, 2]. Although multiple toxicities have been attributed to the vasoconstrictive properties of cyclosporine [4], the pathophysiology of these patients' bone pain syndrome remains unknown.We ...References1. Bouteiller G, Lloveras JJ, Condouret J, Durroux R, Durand D. Syndrome aligique polyarticulaire probablement induit par la ciclosporine (SAPPIC) chez trois transplantes renaux et un transplante cardiaque. Rev Rhum Mal Osteoartic. 1989; 56:753-5. Google Scholar2. Lucas V, Hourmant M, Soulillou JP, Rossard A, Prost A. Douleurs osseuses epiphysaires rapportees a la ciclosporine A chez 28 transplantes renaux. Rev Rhum Mal Osteoartic. 1990; 57:79-84. Google Scholar3. Lucas VP, Ponge TD, Plougastel-Lucas ML, Glemain P, Hourmant M, Soulillou JP. Musculoskeletal pain in renal-transplant recipients (Letter). N Engl J Med. 1991; 25:1449-50. Google Scholar4. Kahan BD. Cyclosporine. N Engl J Med. 1989; 321:1725-38. Google Scholar5. Goffin E, vande Berg B, Pirson Y, Malghem J, Maldague B, van Ypersele de Strihou C. Epiphyseal impaction as a cause of severe osteoarticular pain of lower limbs after renal transplantation. Kid Int. 1993; 44:98-106. Google Scholar6. Mankin HJ. Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med. 1992; 326:1473-9. Google Scholar7. Arlet J. Nontraumatic avascular necrosis of the femoral head: Past, present, and future. Clin Orthop. 1992; 277:12-21. Google Scholar8. Zizic TM, Marcoux C, Hungerford DS, Stevens MB. The early diagnosis of ischemic necrosis of bone. Arthritis Rheum. 1986; 29:1177-86. Google Scholar9. LaRoche M, Jacquemier JM, Montane de La Roque P, Arlet J, Mazieres B. La nifedipine per os ameliore les douleurs de l'osteonecrose de la tete femorale. Rev Rhum Mal Osteoartic. 1990; 57:669-70. Google Scholar10. Arlet J, Mazieres B, Thiechart M, Vallieres G. The effect of IV injection of naftidofuryl on intra-medullary pressure in patients with osteonecrosis of the femoral head. In: Arlet J, Mazieres B. Bone Circulation and Bone Necrosis. Berlin: Springer-Verlag; 1990. Google Scholar Author, Article, and Disclosure InformationAffiliations: From the University of Washington, Seattle, Washington.Corresponding Author: V. Joyce Gauthier, MD, PhD, Department of Medicine, RG-28, University of Washington, Seattle, WA 98195.Acknowledgments: The authors thank Drs. Connie Davis and Ganesh Raghu, the other members of the Transplant Services, and Dr. Jeffrey Carlin for referring their patients for evaluation; and Sandrine Graulich, Sylvain Thiebaut, and Drs. Nancy Karr, Maria Alaves, Mart Mannik, Peter Simkin, and Michael L. Richardson for their assistance and insights.Grant Support: In part by grants R29-DK43050 from the National Institute of Diabetes and Digestive and Kidney Diseases and T32-AR07108 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. 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