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Puffy hand syndrome due to drug addiction: a case–control study of the pathogenesis

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ABSTRACT Aim 

We studied the pathogenesis of puffy hand syndrome of intravenous drug use. We hypothesized that injections of high-dose sublingual buprenorphine, instead of the recommended sublingual administration, could play an important role in lymphatic obstruction and destruction. Design and participants 

We set up a case–control study in substitution centres, recruiting intravenous drug addicts with and without puffy hands, respectively. The subjects were asked to answer anonymously a questionnaire of 40 items comprising social and demographic status, history of illicit drugs use, buprenorphine misuse and injection practices. Findings 

We included 33 cases and 33 controls, mean age of 34 years. They were past heroin users, mainly methadone-substituted. In multivariate analysis, sex (women) (OR = 8.9, P = 0.03), injections in the hands (OR = 5.9, P = 0.03), injections in the feet (OR = 6.5, P = 0.01) and the absence of tourniquet (OR = 7.0, p = 0.02) were significant risk factors for puffy hand syndrome. In 69.7% of the cases and 59.4% of the controls, respectively, there was a high-dose sublingual buprenorphine misuse, although it appeared not to be a significant risk factor for puffy hand syndrome. Conclusions 

Injection practices are likely to cause puffy hands syndrome, but buprenorphine misuse should not be considered as a significant risk factor. However, intravenous drug users must still be warned of local and systemic complications of intravenous drug misuse.
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Keywords: Buprenorphine; intravenous drug use; puffy hand syndrome

Document Type: Research Article

Affiliations: 1: Hypertension Maladies vasculaires Pharmacologie clinique, Hôpitaux Universitaires, 2: Laboratoire d’épidémiologie et de Santé publique EA 1801, Faculté de Médecine, 3: Centre de Pharmacovigilance 4: and Médecine interne A, Hôpitaux Universitaires, Université Louis Pasteur, Strasbourg, France

Publication date: 01 September 2006

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