Multifocal osteonecrosis in a patient with anamnestic ulcerative colitis. Is there a relationship with the disease and the use of glucocorticoids twenty years before? A brief review of the literature.
In 2013 a 40 year old man came to visit in our Rheumatology Unit because of a recent bilateral shoulder and hip pain. He had been treated from 1990 to 2000 with Cyclosporin A and Sulfasalazyn because of an ulcerative colitis which was completely in remission from 2000 . Glucocorticoids at the mean daily dose of 50 mg were administered only in the first period (1990-92). X-plain rays showed a suspicious multifocal osteonecrosis of both femoral and humeral heads. Magnetic Resonance confirmed the diagnosis (stage III and IV following Ficat and Arlet's criteria). The patient was treated with a cycle of hyperbaric oxygen therapy, with two cycles of intravenous clodronate and with a 2-month cycle of teriparatide. The treatment was able to save a sufficient function for both shoulders, while for both hips arthroplasty the surgery was required. The risks of osteonecrosis linked to inflammatory bowel diseases or to its therapy are discussed.
Rheumatology and Rehabilitation Unit - Salvatore Maugeri Foundation IRCCS, Castel Goffedo, Mantova.
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Saviola
Rheumatology and Rehabilitation Unit - Salvatore Maugeri Foundation IRCCS, Castel Goffedo, Mantova.
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Abdi-Ali
Laboratory and Clinical Biochemistry Unit- Salvatore Maugeri Foundation IRCCS, Castel Goffedo, Mantova.
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Sacco
Department of Medicine- University of Verona, Italy.
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Dalle Carbonare
D000328:Adult; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy*; D016572:Cyclosporine / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010020:Osteonecrosis / Q000150:complications*; D012306:Risk; D012460:Sulfasalazine / Q000627:therapeutic use
D005938:Glucocorticoids; D012460:Sulfasalazine; D016572:Cyclosporine
Clodronate; Glucocorticoid induced osteonecrosisost; Multifocal avascular osteonecrosis; Ulcerative colitis