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A Study of Role of Serotonin and Its Metabolites Causing Joint Pains/ Shoulder Hand Syndrome in Patients With Pulmonary Tuberculosis Taking Isoniazid-Containing Regimens FREE TO VIEW

Jai Kishan, MBBS; Rennis Davis; Kiranjeet Kaur; Neelam Verma
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TB & Chest Hospital, Patiala, India


Chest. 2003;124(4_MeetingAbstracts):212S-b-213S. doi:10.1378/chest.124.4_MeetingAbstracts.212S-b
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PURPOSE:  Joint pains/shoulder hand syndrome is known to occur in patients on antitubercular therapy especially INH. Degradation of serotonin is strongly inhibited by INH. study was to find correlation between INH, joint pains/SHS, serotonin and its metabolites patients.

METHODS:  Serotonin and 5-HIAA levels in blood and urine were estimated by Cox and Perhach (1973) method. Group-I:30 patients of PTB on INH containing regimen but no joint symptoms, Group-II:30 Patients of PTB on INH containing regimen who developed joint symptoms/SHS (Other causes of joint pains/SHS excluded) Group-III:20 patients taking INH chemoprophylaxis.

RESULTS:  In Group-I : Blood and urine serotonin was significantly raised and blood 5-HIAA was highly significantly raised when levels at beginning & 3rd month were compared. At 6th month only urine 5-HIAA levels were highly significantly raised. Mean urine 5-HIAA levels were 1.33+0.8 at beginning and 2.24+0.82 at 6 months.In Group-II : Mean blood serotonin levels were 3.28+2.26 and mean urinary 5-HIAA levels were 2.47+ 1.65. This was statistically highly raised when compared with the levels of patients of pulmonary tuberculosis at beginning without joint symptoms/SHS.In Group-III : Mean 5-HIAA levels were 1.32+ 0.67 at beginning and 2.6+ 0.71 at 3 months. Difference was statistically highly significant.

CONCLUSION:  In patients of pulmonary tuberculosis correlation exists between isoniazid, joint pains/SHS, serotonin and its metabolites. Levels of serotonin and 5-HIAA changes with duration of treatment and activity of pulmonary tuberculosis by the lungs. There is a difference in handling of serotonin in diseased lung due to tuberculosis and relatively healthy lung in patients taking INH chemoprophylaxis. Probably serotonin cause joint symptoms/SHS by vasoconstriction , leading to ischaemia/ischemic necrosis causing inflammation . Condition responds to steroids, vasodilators and anti-inflammatory drugs.

CLINICAL IMPLICATIONS:  Joint symptoms/SHS in patients of PTB on INH containing regimens need to be recognized at an early stage, otherwise permanent changes in the form of fibrosis or contractures may develop.

DISCLOSURE:  J. Kishan, None.

Wednesday, October 29, 2003

12:30 PM - 2:00 PM




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