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In distal radius fractures, N-acetylcysteine lessens CRPS-1 risk by lowering proinflammatory mediators and oxidative stress, underscoring its potential as a preventive therapy.
A retrospective, single-center study demonstrated N-acetylcysteine (NAC), an antioxidant known for its anti-inflammatory effects, to be an effective preventive therapy for complex regional pain syndrome type 1 (CRPS-1) in distal radius fractures-affected people. The study’s results point to NAC's ability to curtail the incidence of CRPS-1 by substantially lowering markers of oxidative stress and levels of proinflammatory cytokines.
In total, 60 patients over the age of 50 (mean age 62.8 ± 5.1 years), including 26 males and 34 females, who were treated for distal radius fractures were included. The enrolled subjects were segregated into 2 groups:
CRPS-1, a debilitating condition that can occur after fractures, was diagnosed according to the Budapest criteria during multiple follow-up visits. The serum levels of key inflammatory markers—interleukin (IL)-1 beta, IL-6, and tumor necrosis factor-alpha (TNF-α)—along with markers of oxidative stress, including total oxidant status and total antioxidant status, were estimated at baseline and at the study’s endpoint.
The results illustrated a stark contrast between CRPS-1 positive and negative patients. Those who developed CRPS-1 exhibited markedly higher levels of proinflammatory cytokines (IL-6, TNF-α, IL-1) and elevated oxidative stress markers (total oxidant status and oxidative stress index) while showing lower total antioxidant status levels. As found, the NAC group had a markedly lower incidence of CRPS-1 when compared to the control group (Table 1):
Further analysis via logistic regression indicated that NAC use diminished the odds of developing CRPS-1 by 78%, with an odds ratio of 0.219. This striking reduction underscores NAC's potential as a highly beneficial preventive strategy for CRPS-1. Moreover, NAC drastically lowered the levels of IL-6, TNF-α, and IL-1, suggesting its role in mitigating the inflammatory response that contributes to CRPS-1. In addition, NAC boosted oxidative stress markers, as evidenced by a prominent rise in total antioxidant status and a decrease in total oxidant status and oxidative stress index.
Thus, NAC appears to be a useful non-invasive intervention for CRPS-1 prophylaxis by targeting both inflammation and oxidative stress—two key drivers of the syndrome. By mitigating the incidence of CRPS-1, NAC could improve outcomes for those recovering from wrist fractures, potentially preventing long-term pain, disability, and the requisition for more invasive interventions. This study calls attention to the importance of early intervention in preventing CRPS-1, suggesting that NAC may be a valuable tool to manage fracture patients, particularly those at higher risk for this debilitating syndrome.
Medicine (Baltimore)
Efficacy of N-acetylcysteine in reducing inflammation and oxidative stress to prevent complex regional pain syndrome type 1
Mustafa Dinc et al.
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