Abstract
The immune system has long been thought to be involved in the pathophysiology of complex regional pain syndrome (CRPS). However, not much is known about the role of the immune system and specifically T-cells in the onset and maintenance of this disease. In this study, we aimed to evaluate T-cell activity in CRPS by comparing blood soluble interleukin-2 receptor (sIL-2R) levels between CRPS patients and healthy controls. CRPS patients had statistically significant elevated levels of sIL-2R as compared to healthy controls (median sIL-2R levels: 4151 pg/ml (Q3 − Q1 = 5731 pg/ml − 3546 pg/ml) versus 1907 pg/ml (Q3 − Q1: 2206 pg/ml − 1374 pg/ml), p < 0.001, resp.). Furthermore, sIL-2R level seems to be a good discriminator between CRPS patients and healthy controls with a high sensitivity (90%) and specificity (89.5%). Our finding indicates increased T-cell activity in patients with CRPS. This finding is of considerable relevance as it could point towards a T-cell-mediated inflammatory process in this disease. This could pave the way for new anti-inflammatory therapies in the treatment of CRPS. Furthermore, sIL-2R could be a promising new marker for determining inflammatory disease activity in CRPS.
Highlights
Complex regional pain syndrome (CRPS) is a clinical disorder characterized by severe pain in an affected extremity that is accompanied by sensory, motor, vasomotor, and sudomotor disturbances [1]
Inflammation as an underlying pathogenic mechanism for CRPS has long been a topic of debate, as systemic markers of inflammation such as erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and white blood cell (WBC) count are usually not elevated in CRPS patients [6,7,8]
We examined the levels of soluble interleukin-2 receptor (sIL-2R) in the plasma of 80 adult patients with CRPS type I and compared this to sIL-2R levels measured in 76 anonymous healthy blood bank donors who had given permission to use their blood for future research purposes
Summary
Complex regional pain syndrome (CRPS) is a clinical disorder characterized by severe pain in an affected extremity that is accompanied by sensory, motor, vasomotor, and sudomotor disturbances [1]. Classic signs of inflammation such as pain, swelling, and redness are often present during physical examination, especially in the initial stages of the disease, suggesting that inflammation does contribute to CRPS [9, 10]. The latter is supported by research findings that demonstrated increased levels of the proinflammatory cytokines’ tumor necrosis factor alpha (TNF-α) and interleukin- (IL-) 6 in skin blister fluid of the affected limbs versus the unaffected limbs of CRPS patients [11, 12]. An interesting theory on inflammation in CRPS was put forward by Goebel and Blaes suggesting that CRPS is a novel kind of antibody-mediated autoimmune disease [14]
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