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. 2006 Nov 30:7:91.
doi: 10.1186/1471-2474-7-91.

Increased endothelin-1 and diminished nitric oxide levels in blister fluids of patients with intermediate cold type complex regional pain syndrome type 1

J George Groeneweg  1 , Frank J P M Huygen, Claudia Heijmans-Antonissen, Sjoerd Niehof, Freek J Zijlstra
Affiliations

Increased endothelin-1 and diminished nitric oxide levels in blister fluids of patients with intermediate cold type complex regional pain syndrome type 1

J George Groeneweg et al. BMC Musculoskelet Disord. .

Abstract

Background: In complex regional pain syndrome type 1 (CRPS1) pro-inflammatory mediators and vascular changes play an important role in the sustained development and outcome of the disease. The aim of this study was to determine the involvement of vasoactive substances endothelin-1 (ET-1) and nitric oxide (NO) during early chronic CRPS1.

Methods: Included were 29 patients with CRPS 1 who were diagnosed during the acute stage of their disease and observed during follow-up visits. Disease activity and impairment were determined and artificial suction blisters were made on the CRPS1 and the contralateral extremities for measurements of IL-6, TNF-alpha, ET-1 and nitrate/nitrite (NOx).

Results: The levels of IL-6, TNF-alpha and ET-1 in blister fluid in the CRPS1 extremity versus the contralateral extremity were significantly increased and correlated with each other, whereas NOx levels were decreased.

Conclusion: The NOx/ET-1 ratio appears to be disturbed in the intermediate stage of CRPS, resulting in vasoconstriction and consequently in a diminished tissue blood distribution.

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Figures

Figure 1
Figure 1
Distribution of IL-6 and TNF-α. Distribution of a) IL-6 data and b) TNF-α data from 29 CRPS patients, from both the involved and the contralateral extremity. In each plot, the straight line indicates per definition a CRPS to contralateral ratio of 1.00 in case no difference was observed. Values are plotted on logarithmic scales. c) Box plots of these data, indicating the median, 25–75% interval and the ranges of values, excluding outliers. The Wilcoxon signed ranks test was used to assign differences in paired samples (blister fluid obtained from the CRPS1 and the contralateral extremity in the same patient).
Figure 2
Figure 2
Distribution of Endothelin 1 and Nitric Oxide. Distribution of a) ET-1 data from 22 CRPS patients and b) NOx data from 17 CRPS patients. In each plot, the straight line indicates per definition a CRPS to contralateral ratio of 1.00 in case no difference was observed. Values are plotted on linear scales.c) Box plots of these data, indicating the median, 25–75% interval and the ranges of values, excluding outliers. The Wilcoxon signed ranks test was used to assign differences in paired samples (blister fluid obtained from the CRPS1 and the contralateral extremity in the same patient).
See this image and copyright information in PMC

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