EPIPHYSEAL PAIN SYNDROME IN TRANSPLANTED PATIENTS RECEIVING CYCLOSPORINE

In patients with renal transplant, cyclosporin has been implicated in the occurrence of osteoarticular pain. This syndrome, which we illustr ate by two of our observations, is fairly stereotyped. Osteoarticular pain begins around the second month post-transplant and in a symmetric al pattern involves, knees, ankles, tarsi, less frequently hips, and a lmost never upper limbs. Pain arises on standing and walking, which is severely impeded. Clinical examination is usually normal. Radiographs show patchy, subchondral osteopenia. Bone scintiscan documents numero us foci of increased uptake and MRI multiple areas of T1-weighted low signal intensity and T2-weighted high signal intensity. Pain disappear s in three to six months. Etiopathogeny is still a matter of discussio n with frequent reference to reflex sympathetic dystrophy. The syndrom e could also be related to a cyclosporin-induced increase in bone remo delling. Steroids could contribute, as could the healing of pre-transp lant, renal osteodystrophy. Microfractures are common but it is not kn own whether they are causative through an ensuing reflex sympathetic d ystrophy or whether they are simply but a consequence of increased bon e remodelling.