摘要:大量的藥物促進了鈣焦磷酸鹽沉積病(CPDD)的發生。我們報告2例靜脈注射唑來膦酸治療後發生急性CPDD的案例。病例1：一位63歲的女性在骨質疏鬆性骨折的部位接受椎體成形術。手術後第二天，她接受了5毫克唑來膦酸的靜脈注射。然而24小時後她的右膝蓋出現了急性CPDD。從關節液成分分析和標準X線攝影的結果證實了該診斷。病例2：一位79歲的婦有CPDD的病史是使用糖皮質激素和羥基氯喹治療狼瘡。她每年靜脈輸注唑來膦酸5毫克預防糖皮質激素引起的骨質疏鬆症。同日晚些時候發生關節疼痛和發燒。五天後，她右手腕出現了關節炎，實驗室結果證實出現了係統性炎症和低鈣血症。放射線也顯示發生了CPDD的證據。Medline搜索發現了6例雙磷酸鹽相關的CPDD，其中2例帕米膦酸鹽，2例依地膦酸鹽，1例阿侖膦酸，1例亞硝膦酸。其特征與我們的病人相似，症狀發作時間短，全身炎症多，有低鈣血症的傾向，以及經常有CPDD證據的X線片。雙磷酸鹽相關的CPDD的確罕見，但風濕病學家還是應該重視。同時，患者在進行雙磷酸鹽治療時，應考慮藥物在症狀中的作用。
附原文：Anumber ofmedicationspromote the development of calciumpyrophosphate deposition disease (CPDD). Wereport 2 cases of acute CPDD after intravenous zoledronic acid therapy. Case #1:a 63-year-old female was admitted for vertebroplasty at the site of anosteoporotic fracture. She received an intravenous infusion of zoledronic acid5 mg on the day after the procedure. Acute CPDD developed in her right knee 24hours later. Findings from joint aspiration and standard radiography confirmedthe diagnosis. Case #2:this 79-year-old woman had a history of CPDD was onglucocorticoid and hydroxychloroquine therapy for lupus. She was given anintravenous infusion of zoledronic acid 5 mg as prophylaxis of glucocorticoidinduced osteoporosis. Joint pain and a fever developed later on the sameday.After 5 days, she had arthritis of the right wrist, laboratory evidence ofsystemic inflammation, and hypocalcemia. Radiographs showed evidence of CPDD. AMedline search identified 6 cases of bisphosphonate-related CPDD, including 2due to pamidronate, 2 to etidronate, 1 to alendronic acid, and 1 to neridronicacid. The features were similar to those in our patients, with a shorttime toonset, systemic inflammation in many cases, a tendency toward hypocalcemia, andradiographs that often showed evidence of CPDD. Bisphosphonate-induced CPDD isa rare eventuality that should nevertheless be borne in mind byrheumatologists. Also, in patients with CPDD while taking bisphosphonatetherapy, a role for the drug in the symptoms should be considered.
引自：Couture G, Delzor F, Bagheri H, et al.First cases of calcium pyrophosphate deposition disease after zoledronic acidtherapy[J]. Joint Bone Spine, 2016, 84(2).
