Dear Ms. L -

Although I don't yet have a copy, a fairly detailed abstract to a recent paper suggests that that anti-TNF[alpha] drugs, such as Infliximab (Remecaide) are likely to be effective only in the treatment of accute cases of CRPS, as they were in the study to which you initially made reference:

Systemic inflammatory mediators in post-traumatic complex regional pain syndrome (CRPS I) - longitudinal investigations and differences to control groups, Schinkel C, Scherens A, Köller M, Roellecke G, Muhr G, Maier C, Eur J Med Res. 2009 Mar 17;14(3):130-5

Berufsgenossenschaftliche Kliniken Bergmannsheil, Department of Surgery, Ruhr University, Bochum, Germany. christian.schinkel@ruhr-uni-bochum.de

OBJECTIVES: The Complex Regional Pain Syndrome I (CRPS I) is a disease that might affect an extremity after trauma or operation. The pathogenesis remains yet unclear. It has clinical signs of severe local inflammation as a result of an exaggerated inflammatory response but neurogenic dysregulation also contributes to it. Some studies investigated the role inflammatory mediators and cytokines; however, few longitudinal studies exist and control groups except healthy controls were not investigated yet. METHODS: To get further insights into the role of systemic inflammatory mediators in CRPS I, we investigated a variety of pro-, anti-, or neuro-inflammatory mediators such as C-Reactive Protein (CRP), White Blood Cell Count (WBC), Interleukins 4, 6, 8, 10, 11, 12 (p70), Interferon gamma, Tumor-Necrosis-Factor alpha (TNF-a) and its soluble Receptors I/II, soluble Selectins (E,L,P), Substance-P (SP), and Calcitonin Gene-Related Peptide (CGRP) at different time points in venous blood from patients with acute (AC) and chronic (CC) CRPS I, patients with forearm fractures (FR), with neuralgia (NE), and from healthy volunteers (C). RESULTS: No significant changes for serum parameters investigated in CRPS compared to control groups were found except for CC/C (CGRP p = 0.007), FR/C (CGRP p = 0.048) and AC/CC (IL-12 p = 0.02; TNFRI/II p = 0.01; SP p = 0.049). High interindividual variations were observed. No intra- or interindividual correlation of parameters with clinical course (e.g. chronification) or outcome was detectable. CONCLUSION: Although clinically appearing as inflammation in acute stages, local rather than systemic inflammatory responses seem to be relevant in CRPS. Variable results from different studies might be explained by unpredictable intermittent release of mediators from local inflammatory processes into the blood combined with high interindividual variabilities. A clinically relevant difference to various control groups was not notable in this pilot study. Determination of systemic inflammatory parameters is not yet helpful in diagnostic and follow-up of CRPS I. [Emphasis added.]

PMID: 19380284 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

I am trying to get a copy of this article as soon as I can, and will at once post as to it's availability. But if it's results check out in subsequent studies, there is no reason to think that any of the anti-TNF drugs would be useful in treating chronic cases of CRPS. That said, the whole question of the role of Calcitonin Gene-Related Peptide (CGRP) as either a product of or a predicate for chronic CRPS ("p = 0.007") opens all sorts of vistas. For starters, "Calcitonin Gene-Related Peptide AND brain" just produced 1,244 hits on PubMed.

But back to the topic at hand, and has been pointed out in other threads, Remicade (Infliximab) has a black box warning that's way scary. Check it out at http://www.nlm.nih.gov/medlineplus/d...s/a604023.html A while back, I saw a rheumatologist who suggested that I consider treatment with Remicade, in conjunction with the use of what I later learned was an even scarier drug, Methotrexate, the Medline blurb for which appears at http://www.nlm.nih.gov/medlineplus/d...s/a682019.html (I said pass.)

Finally, unless someone has the facts to correct me, it's my understanding that the other thing about even trying to use Infliximab (Remicade) for the treatment of CRPS is that it's a strickly off label use of a very expensive drug, so there's no possibilty of insurance coverage, at least for those of us in the ol' US of A.

Mike