Treatment with intravenous ketamine eased pain significantly in a patient with rheumatoid arthritis (RA) and fibromyalgia, a case report shows.
The report, “Intravenous Ketamine Alleviates Pain in a Rheumatoid Arthritis Patient With Comorbid Fibromyalgia,” was published in the journal The Journal of Medical Cases.
Patients with RA are at increased risk to develop fibromyalgia. Both disorders disproportionally affect women. RA may be treated with diverse types of medications that target pro-inflammatory cytokines — molecules released by immune cells — including analgesics, non-steroidal anti-inflammatories (NSAIDs), glucocorticoids, and disease-modifying therapies.
However, lack of response in some patients and medication-related problems warrant evaluation of alternative treatments.
Intravenous (IV) ketamine has been an FDA-approved medication for nearly 50 years. Ketamine blocks the NMDA (N-methyl-D-aspartate) receptor, which is key in neuronal communication and is involved in regulating pain signals in the brain and spinal cord. Excessive activation of this receptor may cause toxicity, leading to various pain disorders.
By blocking NMDA receptors, ketamine may correct this over-activation. However, ketamine’s therapeutic effects go well beyond its levels in the body, which leads scientists to speculate that it induces secondary changes that result in durable benefits.
A combination of analgesic, immunomodulatory and anti-inflammatory effects have been proposed for ketamine, which makes it promising for treating RA, according to the authors.
This report describes the case of a 49-year old woman with RA whose arthritis did not respond to conventional treatment options and resulted in permanent, extreme pain. She reported joint pain with stiffness in the morning in hands and shoulders, which limited finger and wrist movement and reduced her quality of life significantly.
The patient also had diffuse muscular pain and met diagnostic criteria for fibromyalgia.
Several treatment options, including physical therapy and conventional medications, “did not achieve adequate pain control for either condition, so I decided to use [IV] ketamine as an alternative therapeutic option,” Ashraf Hanna, MD, the study’s lead author, said in a press release.
The patient started a 10-day IV ketamine infusion treatment for four hours per day. The initial dose was 428 mg, gradually increased to 1,063 mg.
She reported decreased pain after the first infusion session, and being almost pain-free after the last session. She also was no longer experiencing RA symptoms, including joint pain and morning stiffness.
Although he noted this is the first published report on the use of ketamine in RA, Hanna considered that “ketamine appears to possess unique immunomodulatory and analgesic properties that effectively [reduce] inflammation and reduce pain without the use of opioid/NSAID analgesics.”
The authors cautioned that the findings are from only one patient and did not compare ketamine with placebo. However, “we are hopeful that future adequately powered and placebo-controlled clinical trials may confirm that ketamine is safe and effective for the treatment of autoimmune diseases such as RA,” they wrote.
Unlike in the past, ketamine’s effectiveness is now recognized by diverse insurance companies. “We hope to continue to add new Ketamine-compliant insurance companies in 2018,” Hanna said.
“I have provided over 8,000 ketamine infusions and have seen so many incredible successes over the past 5 years. Some of my patients were unable to move a limb or walk and now have complete mobility and can walk unaided.” Hanna said.
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