Abstract
This case report characterizes the clinical course of a 79-year-old man with idiopathic Parkinson disease who developed polyarthralgia following commencement of levodopa-carbidopa therapy, resolution of the polyarthralgia with discontinuation of it, and subsequent reappearance of polyarthralgia when the medication was restarted. The time-locked relationship between polyarthralgia and levodopa-carbidopa treatment suggests that this is an adverse drug reaction. The possible pathophysiologic basis of this unusual reaction is discussed.
Highlights
Levodopa-carbidopa is the mainstay of treatment of Parkinson disease (PD)
While there are reports of arthralgias arising from levodopa-carbidopa therapy, to my knowledge, this is the first detailed description of a time-locked occurrence of polyarthralgias with levodopa-carbidopa treatment
In randomized, controlled clinical trials, shoulder pain was reported in 1% of patients on sustained-release carbidopa/levodopa (n = 491) compared with 0.6% of those on immediate-release carbidopa/levodopa (n = 524) [3,4]
Summary
Levodopa-carbidopa is the mainstay of treatment of Parkinson disease (PD). While there are reports of arthralgias arising from levodopa-carbidopa therapy, to my knowledge, this is the first detailed description of a time-locked occurrence of polyarthralgias with levodopa-carbidopa treatment. When he was seen in clinic a week later, moderate right knee pain and crepitus on movement was noted, but he had no obvious joint swelling, redness, or warmth. Alternate treatment with ropinirole or pramipexole was offered, but he declined this
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