Authors: Sreekanth Vasireddy Amruta Talwalkar Hazel Miller Rakesh Mehan David R Swinson
Publish Date: 2003/10/17
Volume: 22, Issue: 6, Pages: 376-380
Abstract
Twothirds of patients with Paget’s disease seeking medical attention present with pain We studied patterns of pagetic pain in relation to physical activity and the effect of coexistent osteoarthritis OA/pagetic arthropathy on pain and physical activity before and after treatment with pamidronate Patients with lowersegment Paget’s disease lumbar spine pelvis or lower limbs raised alkaline phosphatase ALP and pain as a symptom were included Two subgroups were identified based on the absence P group or presence POA group of radiological OA in the lower segment They received 2–4 fortnightly infusions of pamidronate 30–60 mg and were followed up at 6 weeks 3 months and 6 months Outcome measures were visual analog scales for pain at rest on standing on walking and at night standing time walking distance 50yard walking time and ALP Twentyfive patients 12 men 13 women mean age 701±19 years received a mean of 142±97 mg of pamidronate The P group had higher mean ALP p=0003 and higher scores for pain not significant at baseline than the POA group Compared to baseline P group had significant improvements p001 at 6 months in rest pain standing pain and walking pain The POA group had nonsignificant changes in pain at 6 months ALP improved significantly at 6 months in both subgroups p001 The whole group also improved at 6 months in standing time 557 not significant walking distance 339 not significant and 50yard walking time 242 p005 Paget’s patients with coexistent joint disease had less severe pain and bone disease at baseline than those without coexistent joint disease and responded less well to pamidronate although they did have significant improvement in ALP levels Radiographic assessment for coexisting joint disease prior to treatment might improve prognostication from the patient’s point of view and improve treatment complianceWe would like to thank Kathleen Greenwood research secretary Department of Rheumatology Wrightington Hospital who helped with data processing and Andy Vail biostatistician Research Development Hope Hospital Salford for advice on data analysis
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