Dercum's Disease Support Group

Happy reading! Hugs, Grandma Sylvia

I found this today and thought that it may be helpful regarding Liposuction for the tumours .... cheers lee

Link   http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.2011.10566.x/abstract

SIR, Adiposis dolorosa (Dercum’s disease) is a rare disorder characterized by painful subcutaneous lipomas. Pain treatment with general analgesics often has little or no effect. Weight loss for patients is difficult and there is no guarantee that the lipomas and the pain will disappear even when normal bodyweight is achieved. Surgery may provide temporary pain relief;1 however, the lipomas may recur quickly and surgery is also not without risk. Liposuction, an analogous procedure to surgery, has been reported to be a successful treatment for eliminating

the lipomas and the associated pain.2 Intravenous administration of lidocaine is a nonsurgical treatment.3–5 We report the first case, in a 60-year-old woman, of 15 repetitive successful interventions with intravenous lidocaine to alleviate pain over a period of more than 10 years.

dolorosa): a report of improvement

with infliximab and methotrexate

Editor

A 50 year-old, Caucasian woman with a history of

ankylosing spondylitis and insulin-dependent diabetes

had a 5-year history of increasingly painful bulky tumours.

Surgical excision of a tumour from her right buttock in

2002 revealed a lipoma. In 2003 she was diagnosed with

Dercum’s disease. In July 2004 the patient weighed 362

lbs, with a body mass index of 54.5. Physical examination

revealed multiple, tender, subcutaneous tumours on her

trunk and extremities.

The patient was started on infliximab infusions in

September 2004 at a dose of 3 mg/kg to control her ankylosing

spondylitis. The intervals between infusions were

gradually increased from 2 to 6 weeks. In November 2004

the patient reported improvement in her polyarthritis, an

incidental improvement in the pain from her tumours,

and an 18-lb weight loss. Methotrexate was added to her

regimen, starting at 10 mg/week and then increasing

to 20 mg/week. A month later, the patient reported an

additional 10-lb weight loss. Over the next 6 months the

redness and size of her lipomas continued to regress, and

there was a decrease in subjective pain and in insulin

requirements.

Infliximab and methotrexate were discontinued in May

2005 because of bilateral cellulitis of the lower extremities.

Since this time her pain has recurred, she has gained

15 lb in weight and there has been an increase in her

insulin requirements.

Treatment options for Dercum’s disease are few, and are

often ineffective. Weight loss and common analgesics

have been tried with little to no benefit. Intravenous lidocaine

and low-dose, daily prednisone have helped in only

reduce the number and size of the lipomas as well as

the associated pain, but the tumours usually recur over

time.3

Our patient is the first reported case of improvement in

Dercum’s disease with infliximab therapy. It is unclear

whether the patient’s improvement derived solely from

the infliximab, or if methotrexate played an additive role.

However, we do know her initial improvement occurred

on infliximab alone. TNF-alpha has recently been reported

to play a role in the release of circulating free fatty acids,

as a TNF-alpha inhibitor, may improve Dercum’s

disease by inhibiting this process. Metabolic studies have

shown both alterations in fatty acid metabolism and a

peripheral insulin resistance in Dercum’s patients, suggesting