Posttraumatische dystrofie (CRPS), objectief meetbaar

Onderzoekers van het Centrum voor Pijngeneeskunde van het Erasmus MC hebben een methode ontwikkeld waarmee voor het eerst objectief de activiteit van ontstekingscellen bij het Complex Regionaal Pijn Syndroom (CRPS) gemeten kan worden. Tot nog toe kon CRPS alleen subjectief, door middel van waarneming, worden vastgesteld. De activiteit van de ontstekingscellen blijkt in bloedmonsters van de CRPS-patiënt meetbaar te zijn. De methode is direct toepasbaar in de praktijk [1].

Posttraumatische dystrofie of Complex Regionaal Pijn Syndroom (CRPS), is een complicatie die kan optreden na een operatie of een ongeluk [2].

Jaarlijks krijgen ongeveer 5.000 patiënten CRPS [3]. Patiënten met CRPS hebben in veel gevallen 4 of 5 van de volgende symptomen: onverklaarbare diffuse pijn, veelal brandende pijn in een gebied groter dan het oorspronkelijk letsel, verschil in huidskleur (rood of blauw), diffuus oedeem, zwelling, verschil in huidtemperatuur (warmer of kouder dan het andere ledemaat), actieve bewegingsbeperking o.a. door pijn en stijfheid, het ontstaan of verergeren van symptomen na inspanning. Op een röntgenfoto is vaak botontkalking te zien. Ook kunnen de gewrichten schade hebben opgelopen.

Het Centrum voor Pijngeneeskunde van Erasmus MC doet al vele jaren onderzoek naar de onderliggende mechanismen van dit ziektebeeld. Hierdoor is duidelijk geworden dat een steriele ontsteking een belangrijke rol speelt bij CRPS. Prof. dr. Frank Huygen van het centrum: “Tot nu toe kon de diagnose alleen subjectief gesteld worden op basis van symptomen waarmee de patiënt zich presenteert. Dat de ontstekingsactiviteit in het bloed nu objectief kan worden gemeten, is in zekere zin ook een mate van erkenning voor de patiënt, die zich niet altijd begrepen voelt.”

Promovenda drs. Krishna Bharwani onderzocht de methode om de mate van activiteit van ontstekingscellen bij CRPS vast te stellen. Dit gebeurt door middel van een bepaling van het gehalte van de “soluble IL-2 receptor” in het bloed. Deze methode wordt al toegepast onder andere bij Sarcoïdose om ziekteactiviteit te meten.

Huygen: “De methode is direct toepasbaar bij alle patiënten die zich met een verdenking op een Complex Regionaal Pijn Syndroom (ofwel Posttraumatische dystrofie) presenteren. In de toekomst willen wij die ook gebruiken om het effect van de behandeling van de ontsteking bij CRPS te onderzoeken…”

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Wat kunnen aminozuren betekenen

Alle weefsels en alle functies van een arm of been kunnen door CRPS (ofwel Posttraumatische dystrofie) worden aangetast.

Er zijn aanwijzingen dat CRPS een abnormale (steriele) ontstekingsreactie is waarbij zuurstofradicalen een grote rol spelen. Er zouden teveel zuurstofradicalen worden gevormd waardoor gezond weefsel beschadigd wordt. Het normale herstel zou uit de hand lopen. De kenmerkende verschijnselen bij een ontsteking zijn roodheid, zwelling, warmte, functiestoornis en pijn.

Een grote hoeveelheid wetenschappelijke studies bevestigt de werkzaamheid van specifieke aminozuren (eiwitten), die het bindweefsel ondersteunen en gezonde gewrichten bevorderen. Deze gegevens omvatten in vitro, in vivo en meervoudige placebo-gecontroleerde klinische studies [4].

In vivo onderzoek uitgevoerd aan de universiteit van Rochester Medical Center (USA), bevestigt de unieke voordelen van deze aminozuren in ondersteuning van gezonde gewrichten door regeneratie van kraakbeen en zijn belangrijke ontstekingsremmende werking [5].

Voorts is uit onderzoek gebleken dat mangaan helpt bij de normale vorming van bindweefsel [6], en koper bijdraagt tot de instandhouding van normale bindweefsels, en goed is voor het bindweefsel in de huid [7].

Bindweefsel is weefsel dat bestaat uit vezels die krachten van het bewegen opvangen. Dit komt eigenlijk neer op al het weefsel in het lichaam. Structuren die vallen onder bindweefsel zijn onder meer, botten, spieren, pezen, gewrichtsbanden, gewrichtskapsel, (gewrichts)kraakbeen.

Meer weten over deze aminozuren en mineralen…

 

[1] Voetnoot

Krishna D. Bharwani et al 2017, Centrum voor Pijngeneeskunde Erasmus MC. Complex regional pain syndrome: diagnosis and treatment. BJA Education, Volume 17, Issue 8, 1 August 2017, Pages 262-268. https://doi.org/10.1093/bjaed/mkx007

[2] Voetnoot

Posttraumatische dystrofie, in Nederland ook bekend onder de namen, Complex Regionaal Pijn Syndroom (CRPS), Sudeck Dystrofie (of Atrofie) of Sympathische Reflex Dystrofie.

[3] Voetnoot studies

Patientenvereniging CRPS: http://www.posttraumatischedystrofie.nl/ziektebeeld.html

[4] Voetnoot studies

Jiang, et al. 2014. Collagen Peptides for Treatment of Knee Osteoarthritis: A Double-Blind Randomized, Placebo-Controlled Study. Agro Food Industry Hi Tech 25(2): 20–21.

Van Vijven J.P.J. et al., 2012. Symptomatic and chondroprotective treatment with collagen derivatives in osteoarthritis: a systematic review. Osteoarthritis and Cartilage, 20: 809-821.

Henrotin Y. et al., 2011. Nutraceuticals: do they represent a new era in the management of osteoarthritis? – a narrative review from the lessons taken five products. Osteoarthritis and Cartilage, 19: 1-21.

Ragle R.L. et al., 2012. Nutraceuticals in the management of osteoarthritis: a critical review. Drugs & Aging, 29: 717-731.

Moskowitz, R., 2000. Role of collagen hydrolysate in bone and joint disease. Seminars in Arthritis and Rheumatism, 30: 87-99.

Benito-Ruiz P. et al., 2009. A randomized controlled trial on the efficacy and safety of a food ingredient, collagen hydrolysate, for improving joint comfort. International Journal of Food Sciences and Nutrition, 60:99-113.

Clark, K.L. et al., 2008. 24-Week study on the use of collagen hydrolysate as a dietary supplement in athletes with activityrelated joint pain. Current Medical Research and Opinion, 24: 1485-1496.

[5] Voetnoot studies

Dar Q.A. et al. 2014, Oral hydrolysed type I collagen induces chondroregeneration and inhabits synovial inflammation in murine posttraumatic osteoarthritis , Osteoarthritis and Cartilage. 24:5532-5533.

[6] Voetnoot studies

European Food Safety Authority (EFSA), 2010. Scientific Opinion on the substantiation of health claims related to manganese and reduction of tiredness and fatigue (ID 312), contribution to normal formation of connective tissue (ID 404) and contribution to normal energy yielding metabolism (ID 405) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. DOI: 10.2903/j.efsa.2010.1808.

[7] Voetnoot studies

European Food Safety Authority (EFSA) 2009. Scientific Opinion on the substantiation of health claims related to copper and protection of DNA, proteins and lipids from oxidative damage (ID 263, 1726), function of the immune system (ID 264), maintenance of connective tissues (ID 265, 271, 1722), energy-yielding metabolism (ID 266), function of the nervous system (ID 267), maintenance of skin and hair pigmentation (ID 268, 1724), iron transport (ID 269, 270, 1727), cholesterol metabolism (ID 369), and glucose metabolism (ID 369) pursuant to Article 13(1) of Regulation (EC) No 1924/2006.  DOI: 10.2903/j.efsa.2009.1211.

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