Abstracts

Arthralgias as a consequence of anticonvulsant medications was described initially in 1934 with barbiturates and termed [italic]rhumatisme gardenalique[/italic]. Subsequently, drug-induced lupus-like syndromes, fibromyalgia, and shoulder-hand syndrome have been described with anticonvulsants. We describe two patients with epilepsy treated with anticonvulsants with arthralgias primarily in the hands who improved with discontinuation of phenytoin. Two case reports are described. A 22 year old woman with tonic seizures treated with phenytoin and oxcarbazepine for one year complained of episodically cold hands and occasional aches. Antinuclear antibodies (ANA) were elevated at 1:2560 and antihistone antibodies were 49 (greater than 2.5 is strongly positive). Discontinuation of phenytoin resulted in symptom improvement.
A 56 year old woman treated with phenytoin and valproic acid for 10 years complained of aching joints that became worse over the past year. She had a normal ANA and antihistone antibodies were 1.0 (weakly positive). Phenytoin taper resulted in increased range of motion of her fingers and less aching. Review of the literature identified only 6 reports discussing anticonvulsants as a cause of arthralgias. The presence of arthralgias in the setting of anticonvulsant treatment should raise the possibility of this largely forgotten syndrome, [italic]rhumatisme gardenalique[/italic]. The role of antihistone and antinuclear antibodies in the syndrome is unclear. Recognition of this syndrome is important because withdrawal of the offending anticonvulsant can lead to improvement of symptoms.