RSD Puzzle #026

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

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EPILEPSY, PAIN, MS

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RSD PUZZLE #26
"CAN RSD BE INHERITED?"

The answer is a qualified no. RSD is a syndrome brought on by multiple factors (e.g., minor trauma, inactivity, pre-existing injury, and trauma to specific water-shed zones). It cannot be simply inherited.

In our series of 386 consecutive patients diagnosed as suffering from RSD, only 4 families (with more than one member of the family suffering from RSD) were identified.

1. In the first family, two sisters suffering from Fabre' Disease (lipid metabolism disease of genetic nature). Fabre' Disease selectively involves small blood vessels and secondarily has a high tendency for development of RSD (or, more frequently, simple sympathetically maintained pain). As it affects the small arteries, it involves the sympathetic nerves surrounding them. It is not RSD, but the pre-existing genetic disease that made the members of the family susceptible to it.

2. In the second family, there was a strong tendency for auto-immune disease. A mother and her two daughters suffered from RSD. The mother also suffered from Sjogern's Disease, and one of the sisters suffered from lupus (LE). All three ladies had abnormal T-cell lymphocyte ratios. The treatment was aimed at both treating the RSD and treating the auto-immune disease. It is well known that 5% of patients with auto-immune disease (e.g., rheumatoid arthritis, MS, lupus, etc) show a hereditary familial tendency.

3. In the third family, a brother and a sister suffered from RSD. The brother developed RSD after an lightning strike and the sister developed RSD after a mild lumbar spine injury. Both patients had a rough course and eventually needed infusion pump treatment.

4. In the forth family, two sisters and one cousin suffered from RSD at different stages of life, yet every one of them was precipitated by spinal trauma.

Realizing that RSD comprises somewhere between 5-6% of the chronic pain patients, the familial tendency is explained by either coincidence, or other type of hereditary diseases rather than the RSD itself being a pure genetic disease.

Mailis and colleagues [1] have observed abnormal human lymphocytic antigens (HLA) elevation in some RSD patients. Eighty percent of such patients were resistant to treatment. Further study in this regard may help us understand the role of genetics in RSD.

H. Hooshmand, MD

1. Mailis A, Meindole H, Papagapiou M, et al: Alteration of the three-phase bone scan after sympathectomy.

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