AKRON, Ohio—Children treated with the central nervous system (CNS) stimulants methylphenidate or dextroamphetamine for attention deficit hyperactivity disorder (ADHD) are at elevated risk for developing Raynaud's syndrome (RS), according to William Goldman, DO, of Akron Children's Hospital and Medical Center in Ohio. Dr. Goldman reported this case-control study in Arthritis & Rheumatism.1
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"The results of this study indicate that there is a significant association between development of RS and therapy with CNS stimulants used for the treatment of ADHD. Although this was a small study, the findings provide preliminary evidence of an adverse effect of CNS stimulant medications in patients seen in rheumatology practice," Dr. Goldman said.
Rising use of ADHD drugs may mean more cases of RS in younger patients
Dr. Goldman and colleagues studied all patients seen in a pediatric rheumatology practice over 5 years who met diagnostic criteria for RS as determined by pulse volume recording. The 32 cases were matched with 32 randomly selected patients at the same clinic who did not have signs or symptoms of RS and who were matched for age, sex, and time of presentation. Mean age was 16.1 years for cases and 15.9 years for controls.
The researchers explained, "In the last few years, pediatric rheumatologists have begun to see more patients with RS who have been recently treated with CNS stimulants (eg, methylphenidate, dextroamphetamine) for ADHD. Although CNS stimulants are not known to have any direct role in microvascular circulation, drugs used for the treatment of ADHD might aggravate symptoms and signs of RS." This case-control study was undertaken to investigate that possibility.
The analysis showed a significant association between past or current use of ADHD stimulants and the presence of RS (P = .01). Other CNS medications were not associated with the presence of RS.
"A possible mechanism of action for the association observed in the present study might be CNS stimulation of dopaminergic and noradrenergic systems, which in turn causes the release of catecholamines. Such a release would lead to manifestation or aggravation of signs and symptoms of RS," Dr. Goldman said.
Translating research into practice
In view of growing use of ADHD drugs, the findings have immediate clinical implications.
"Physicians should be aware that in children with signs and symptoms of RS (cold hands and feet and livedo reticularis), these signs and symptoms may worsen if CNS stimulants are taken," Dr. Goldman said.
Reference
1. Goldman W, Seltzer R, Reuman P. Association between treatment with central nervous system stimulants and Raynaud's syndrome in children. A retrospective case-control study of rheumatology patients. Arthritis Rheum. 2008;58:563-566.
Hey Lynn, can you provide a link for this study? I can't find anything about this on the www.bumpSorry, I missed this ...here's where I read it.
http://www.mskreport.com/articles.cfm?articleID=2868
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