voner
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http://www.ncbi.nlm.nih.gov/pubmed/26011726
I did not know These auto antibody tests existed.
The plasma exchange success prompted them to start rituximab.
if someone would like a copy of this paper, they can request it from me over in the "Request a paper" thread.
comments?
Complex Regional Pain Syndrome and Dysautonomia in a 14-Year-Old Girl Responsive to Therapeutic Plasma Exchange
Reflex sympathetic dystrophy, also known as complex regional pain syndrome (CRPS), has recently been shown to be associated with autoantibodies against b2-adrenergic and muscarinic M2 receptors. In addition to pain and sudo- motor/vasomotor symptoms, dysautonomia is also observed in a subset of CRPS patients. Despite its severity, there are few effective therapies for CRPS described to date. We report a case of a 14-year-old girl with CRPS of her right leg and dysautonomia (gastroparesis, postural tachycardia) refractory to multiple therapies, successfully treated with therapeutic plasma exchange (TPE) with albumin replacement. The patient, who has serum anti b2- adrenergic and muscarinic M2 receptor autoantibodies in addition to nicotinic acetylcholine receptor ganglionic autoantibodies, underwent an initial course of five TPEs over a 2-week period. She demonstrated a clinical response to TPE as manifested by a rapid improvement in her fatigue and gastroparesis, with a gradual yet significant improvement in her leg pain and sudomotor/vasomotor flares. Following the loading procedures, the patient was treated with rituximab. She continues to require periodic TPE to maintain a remission, with additional immunosup- pression being considered long term. Although further studies are needed, TPE (in combination with immunosup- pression) may be an appropriate therapy for CRPS patients with detectable autoantibodies, as it is for better characterized diseases with autoantibodies against neuronal surface receptors such as myasthenia gravis or Lambert C 2015 Wiley Periodicals, Inc. Eaton myasthenic syndrome. J. Clin. Apheresis 00:000–000, 2015
I did not know These auto antibody tests existed.
......Given worsening dysautonomic symptoms, the patient’s serum was sent to Mayo Medical Laboratories (Rochester, MN) for an Autoimmune Dysautonomia evaluation. The testing revealed an acetylcholine receptor ganglionic neuronal antibody (0.08 nmol/L; refer- ence value 0.02).
Serum was also sent to Berlin Cures GmbH (Berlin, Germany), and........ two different autoantibodies were identified in this patient’s serum. One was directed against the b2-adrenergic receptor, and increased the beating rate of the cardiomyocytes .........The other autoantibody detected was directed against the muscarinic M2 receptor.....
The plasma exchange success prompted them to start rituximab.
Our patient has required weekly TPE to control her symptoms, thus prompting a trial of rituximab. To the authors’ knowledge, utilization of rituximab for CRPS has never previously been published in the medical literature, though it has been used successfully in dysautonomia.....
...Longer term follow-up is needed before the efficacy of rituximab in this case can be commented on.....
if someone would like a copy of this paper, they can request it from me over in the "Request a paper" thread.
comments?