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Q: reflex sympathetic dystrophy/complex regional pain syndrome I ( Answered,   0 Comments )
Question  
Subject: reflex sympathetic dystrophy/complex regional pain syndrome I
Category: Health > Conditions and Diseases
Asked by: psych7474-ga
List Price: $50.00
Posted: 07 Oct 2003 02:16 PDT
Expires: 06 Nov 2003 01:16 PST
Question ID: 263378
Has the tuberculin skin test (AKA PPD skin test) ever been reported to
cause  reflex sympathic dystrophy (AKA complex regional pain syndrome
I)?

Request for Question Clarification by cath-ga on 07 Oct 2003 15:09 PDT
Hi psych,

I've thoroughly researched your question, but I'm waiting for
some return e-mails. I should have your answer soon! cath-ga

Clarification of Question by psych7474-ga on 07 Oct 2003 15:58 PDT
What would you like me to clarify?

Clarification of Question by psych7474-ga on 08 Oct 2003 09:27 PDT
Again, I would be pleased to clarify anything. When can I expect an
answer? Thank you.

Request for Question Clarification by cath-ga on 08 Oct 2003 10:30 PDT
pysch,

I didn't realy need you to clarify, I just notified you under
that heading that I'm working on it, so you'd know there
was progress being made. I'm hoping to have your answer today.
Do you have a deadline? cath-ga
Answer  
Subject: Re: reflex sympathetic dystrophy/complex regional pain syndrome I
Answered By: cath-ga on 08 Oct 2003 13:35 PDT
 
Dear psych,

If there is a connection between  Reflex Sympathetic Dystrophy
Syndrome and the tuberculin test, it is not yet documented. 
My extensive search turned up no reports of the PPD test linked
to RSDS.

The most complete list of causes of RSDS I found was on
Medicinenet.com,
at: 

http://216.239.41.104/search?q=cache:HleUVrdMEEcJ:www.medicinenet.com/Reflex_Sympathetic_Dystrophy_Syndrome/article.htm+rsds+%2B+tuberculosis&hl=en&ie=UTF-8

They do not mendtion the PPD test, but they do mention  “drugs for
tuberculosis” as a possible trigger:

“The exact mechanism of how RSDS develops is poorly understood. The
theories include irritation and abnormal excitation of nervous tissue,
leading to abnormal impulses along nerves that affect blood vessels
and skin. A variety of events can trigger the condition, including
trauma, surgery, heart disease, degenerative arthritis of the neck,
stroke or other brain diseases, nerve
irritation by entrapment (such as carpal tunnel syndrome) or shingles,
shoulder problems, breast cancer, and drugs for tuberculosis and
barbiturates. There is no associated event in one third of patients.”

According to the Medical Encyclopedia on Medilineplus:

http://www.nlm.nih.gov/medlineplus/ency/article/000077.htm


the primary drugs used to treat tuberculosis are combinations of 
rifampin, isoniazid, pyrazinamide, and ethambutol.

Prothionamide, streptomycin, cycloserine may also be used,
according to the Tuberculosis Medication Fact Sheet at:

http://216.239.41.104/search?q=cache:FIVFnFCGiSoJ:www.health.qld.gov.au/phs/Documents/shs/9046dmp.htm+tuberculosis+medication&hl=en&start=2&ie=UTF-8

The National Institute of Neurological Disorders and Stroke reports
that the cause of RSDS  is unknown.  The NINDS has an
information page on Reflex Sympathetic Dystrophy Syndrome,
at:

http://www.ninds.nih.gov/health_and_medical/disorders/reflex_sympathetic_dystrophy.htm

Here they say that the pain associated with RSDS usually begins at
the site of any injury, especially one caused by a bullet or shrapnel.
The syndrome’s pain often appears all out of proportion to the
severity of
the injury. And RSDS  can also occur without apparent injury. They go
on to say, “One visible sign of RSDS near the site of injury is warm,
shiny red skin that later becomes cool and bluish. “ The pain of RSDS
grows worse over time, and “eventually the joints become stiff from
disuse,
and the skin, muscles, and bone atrophy. The disorder is unique in
that it simultaneously affects the nerves, skin, muscles, blood
vessels, and bones.”

Medlineplus, at:

http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202761.html#SXX13


 lists the following as the side effects of the PPD test :

“
	Rare 
o	Skin rash or itching; redness, blistering, peeling, or loosening of
the skin
	Less common 
o	Pain; redness at the site of injection ;  sores at and around the
place of injection”

According to the New York City Dept. of Health and Mental Hygiene

http://www.ci.nyc.ny.us/html/doh/html/tb/tbskin.html

“Side effects are uncommon from the Mantoux tuberculin skin test.
However,
a person who has been exposed to TB germs may occasionally have a
sizable reaction, which may cause the arm to swell and may cause some
discomfort.
This swelling should disappear in about two weeks. “

Neither site makes any reference to RSDS.

The Reflex Sympathetic Dystrophy Association lists injuries and
surgery as frequent causes of the syndrome, on their
webpage, "Fact and Fiction regarding RSD." They make no
mention of the tuberculin test.

http://www.rsds.org/fact.html


There is a great deal of research on-going into RSDS. You can view the
studies that are looking for patient volunteers at Clinicaltrials.gov,
a service of the National Institutes of Health:

http://clinicaltrials.gov/search/term=Reflex%20Sympathetic%20Dystrophy%20Syndrome

Hoping for some anecdotal evidence of the tuberculin test connection,
I searched  message boards on Google Groups, and found no matches with
these strategies:

reflex sympathetic dystrophy + tuberculin test
rsds + tuberculin
rsds + PPD
rsds + mantoux
reflex sympathetic dystrophy + mantoux
complex  regional  pain syndrome +  mantoux
complex regional pain syndrome + tuberculin
rsds + tuberculosis
reflex sympathetic dystrophy + tuberculosis

Likewise the Yahoo RSDS e-groups, looking for
the above matches with no results.

Yahoo lists four such groups, which you can find at:

http://groups.yahoo.com/search?query=rsds

I sent e-mails to four different sources at the RSDS Association.
I have not heard back from them, but I am not optimistic that
they will have any information on this, considering that the
RSDS message boards don’t have any mention of it. I will
notify you if I hear from them. 

It is, of course, very difficult to prove a negative. However, given
the wide search I have done, I feel confident that if the PPD skin
test was ever reported to cause RSDS, that connection hasn’t 
been given much credibility (yet).

Remember what your high-school biology professor said about
concurrence and causality? “Just because my big toe got bigger
and I got taller at the same time, doesn’t mean my big toe
caused me to grow taller.” If a case of RSDS occurred shortly
after a tuberculin skin test, there is concurrence, but not 
necessarily causality.

If you or someone you know has RSDS, my heart goes out to you.
From what I’ve read, it is a very serious and painful disease.

Please ask my to clarify anything you find unclear, before you
rate my answer. Sorry we didn’t find what you were looking
for. 

Sincerely, 
cath-ga

Search strategy on Google:

tuberculin + RSDS (and full name)
PPD + RSDS (and full name)
tuberculosis + RSDS (and full name)

Clarification of Answer by cath-ga on 09 Oct 2003 15:37 PDT
Hi there again,

I received an e-mail today from Stephen Bruehl, Ph.D.,
Assistant Professor of Anesthesiology, Vanderbilt University School 
of Medicine, who is with the RSDS association. He said
that he has never heard of the tuberculin test causing RSDS,
but if the pin-prick injured or bruised a nerve, it would
not be impossible. cath-ga

Clarification of Answer by cath-ga on 10 Oct 2003 10:25 PDT
I got another e-mail today from Linda Lang of the RSDS Association.
She also says, "I have not heard of it but it is entirely possible. 
Any injection can cause the onset of the syndrome.  Anything that
breaks the skin (soft tissue damage) has the potential for onset of
RSD, although such a tiny
injury as causal would be rare."
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