The effect of intravenous pamidronate on refractory rheumatoid arthritis

Patients with Rheumatoid arthritis may resistant to conventional treatment with DMARDs and biologic therapy is costly and may be inconvenient for many of patients. Pamidronate is a potent bisphosphonates with the capacity of modifying the biological activity of the immune system cells, thus it may be used as an anti-inflammatory agent in patients with inflammatory joint diseases. To assess the effectiveness of Pamidronate in the management of Rheumatoid arthritis, we chose thirty eight patients with rheumatoid arthritis to take part in a pilot study to receive a combination of pamidronte and conventional treatment with prednisolon and Disease Modifying Anti Rheumatic Drugs. These patients received 60 mg of pamidronate in 3 consecutive months and for six more months since the first infusion. The Mean Visual Analogue Score (VAS) and Mean Disease Activity Score(DAS28) were steady until one month after the third infusion but showed no improvement in the next three months after the last infusion of the drug. All except one patient reported a decrease in pain in response to three consecutive pulses of pamidronate and most had improvements in the laboratory and clinical indices that were assessed. The drug was tolerated well by our patients. Pamidronate infusions had a beneficial effect on various clinical and laboratory parameters of patients, but alleviation of symptoms were temporary (more than 6 months) This treatment can be an option for difficult cases of rheumatoid arthritis with severe pain and osteoporosis.