Avascular necrosis after a steroid injection (original) (raw)
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Clinical Imaging, 2003
Septic arthritis of the hip is a serious medical condition that can result in permanent joint dysfunction. This is a case of a 65-year-old woman who underwent therapeutic intraarticular steroid/lidocaine injection for hip pain and subsequently developed septic arthritis. It is critical that radiologists performing these procedures maintain a high index of suspicion in symptomatic patients following intraarticular injections to prevent destruction of the joint. D
Experience of Avascular Necrosis of Hip Joint due to Unjustified Use of Steroid: A Case Series Study
Bangladesh Journal of Pain, 2023
The use of steroids, whether in herbal or synthetic form, for purposes such as weight gain, appetite enhancement, and pain relief is a prevalent practice in Bangladesh. Lacking adherence to pharmacological guidelines, such as those outlined by the American College of Rheumatology (ACR) poses a significant health risk. Steroid-induced osteonecrosis is one in many adverse effects that consuming OTC steroid causes. AVN is characterized by the death of bone tissue due to the prolonged use or high-dose administration of corticosteroids. Commonly affected areas include the hip joints, knees, and shoulders. However, this seemingly innocuous trend has prompted concern, particularly at the Dhaka Specialized Pain Management and Research Centre, where a notable pattern has emerged. From July 2022 to June 2023, a total of 6 (six) reported cases highlighted a worrisome trend of individuals encountering health issues due to the misuse or prolonged use of over-the-counter (OTC) steroids. The majority of the reported cases were male, predominantly in their 2nd to 3rd decade of life. The common thread among these cases was the history of oral steroid ingestion, either in the form of herbal or synthetic compounds. The patients presented with complaints of pain in the hip and groin area, particularly during walking. Diagnostic imaging, including X-ray and MRI of the hip joints, consistently revealed a classical picture of Avascular Necrosis (AVN), underlining the potential association between steroid use and this debilitating condition. The cases reported at the Dhaka Specialized Pain Management and Research Centre serve as a stark reminder of the potential consequences, such as AVN, that can arise from the uninformed or unsupervised use of steroids.
Arthritis & Rheumatism, 2004
We read with interest the recent report by the Wegener's Granulomatosis Etanercept Trial (WGET) Research Group on differences between what they defined as "limited" and "severe" forms of WG with regard to clinical features, antineutrophil cytoplasmic antibody (ANCA) serology, and biopsy findings (1). In his original report on 3 patients with a previously unrecognized new disease entity, Friedrich Wegener concentrated on vasculitic features, but soon he stressed the importance of granuloma formation in what became known as Wegener's granulomatosis in the 1950s (2). Later, a study by Fienberg suggested that WG may start as granulomatous disease in the respiratory tract, and that vasculitis may evolve subsequently (3). Meanwhile, numerous clinical and experimental studies have demonstrated that interaction of ANCA with neutrophils leads to endothelial damage, subsequent vasculitis, and leukocyte recruitment, but the relationship between vasculitic and granulomatous lesions needs to be further clarified (for review, see ref. 4). As has been noted in earlier studies (5), the WGET Research Group detected ANCA (by immunofluorescence) and anti-proteinase 3 antibodies (PR3 ANCA) (by enzyme-linked immunosorbent assay) less frequently in patients with limited disease than in patients with generalized WG (1). This may reflect true differences of disease stage, but further methodical improvements, such as use of capture ELISA or detection of ANCA directed against the pro form of PR3, may be more sensitive in the early stages of the disease and to changes in disease activity (6). Carrington and Liebow introduced the term limited WG to characterize predominant involvement of the lungs in the absence of kidney involvement (7). Some patients may present with isolated meningocerebral inflammation or ophthalmic involvement without renal manifestations and the absence of ANCA (8). The European Vasculitis Study Group (EUVAS) refined the term limited WG by determining 2 subgroups previously subsumed under the category of limited forms. The determination of subgroups was based on clinical and pathologic considerations in order to define disease stages. Localized WG was defined as WG restricted to the upper and/or lower respiratory tract. Early systemic WG included any organ involvement except renal, or imminent vital organ failure. Finally, generalized WG included renal involvement and/or imminent organ failure. Two other subgroups, namely, severe renal and refractory disease, were defined to cover the spectrum of disease and to enroll patients into appropriate stage-adopted treatment trials (9). It is obvious that the WGET Research Group's definition of limited WG as the absence of an immediate threat necessitating aggressive therapy, and that of severe WG as all other patients (1), differs from the EUVAS definitions and may cause confusion. Whereas the EUVAS defined disease stages (9), the WGET Research Group defined 2 groups of patients according to disease activity at the time of enrollment LETTERS 335
SAS Weekly Rounds: Avascular Necrosis
HSS Journal, 2009
Osteonecrosis of the femoral head is a condition that affects upwards of 10,000 individuals in the USA each year. The peak incidence is in the fourth decade of life, and overall, there is a male preponderance. The condition accounts for up to 12% of total hip arthroplasties performed in developed countries. The etiology can be traumatic or non-traumatic, with 90% of atraumatic cases attributed to corticosteroid therapy or excess alcohol consumption. Osteonecrosis of the femoral head reflects the final common pathway of a range of insults to the blood supply and ultimately results in femoral head collapse, acetabular involvement, and secondary osteoarthritis. Currently, conservative treatment options, which aim to correct pathophysiologic features allowing revascularization and new bone formation, appear to be able to delay but not halt the progression of this condition. As a consequence of femoral head osteonecrosis, many individuals undergo surgical treatments including: core decompression, osteotomy, non-vascularized bone matrix grafting, free vascularized fibular grafts, limited femoral resurfacing, total hip resurfacing, and total hip arthroplasty.
Acta orthopaedica et traumatologica turcica, 2007
We investigated the effect of corticosteroid treatment on the femoral head of healthy and serum disease-induced rats. Thirty Sprague-Dawley rats weighing 250-300 g were divided into three groups equal in number. In group A, serum disease was induced by two intraperitoneal injections of sterile human serum (10 ml/kg), interspersed with a two-week interval. The rats were then treated with methylprednisolone (40 mg/kg/day) for three consecutive days two weeks after the last injection. In group B, the animals received only methylprednisolone (40 mg/kg/day) for three days. In group C (controls), the same procedures were applied as those in group A, but with saline solution alone. All the rats were sacrificed two weeks after the last procedure. The left and right femora were sectioned axially and sagittally, respectively, to be examined under light microscopy with respect to vasculitis, hemorrhage in bone marrow, and changes in cell morphology. Histological examination showed decreased bo...
Corticosteroid induced avascular necrosis and COVID-19: The drug dilemma
Nepal Journal of Epidemiology
The severe and life-threatening nature of the COVID-19 infection, the ARDS (acute respiratory distress syndrome) as well as the cytokine storm induced by the infection, commands lifesaving high doses of steroid therapy. As in all pharmacological therapies adverse effects are present. One such adverse effect which is being reported is corticosteroid induced avascular necrosis of the femoral head/ osteonecrosis of the femoral head. It must be noted that AVN principally affects the femoral head and most commonly the anterolateral aspect thereof as it is the crux of weight bearing. Corticosteroids induce fat mobilization and this thus innately enhances the likelihood of fat emboli developing from the liver to occlude minor blood vessels in the femur, this thereby compromises the microvascular environment. Superadded to this the steroid therapy disrupts calcium metabolism and homeostasis which induces hypertrophy in the intramedullary fat cells, Gaucher cells and inflammatory cells; whi...
Corticosteroid pulse therapy-associated aseptic humeral and femoral head necrosis: a case report
Drugs & Therapy Perspectives, 2019
Corticosteroid pulse therapy is the administration of suprapharmacologic doses of corticosteroids in an intermittent manner to enhance their therapeutic effects and reduce their adverse effects. This report describes the complications of pulse therapy and long-term use of corticosteroids in a male patient aged 37 years who has had multiple sclerosis since 2003. The patient was diagnosed with aseptic necrosis of the humerus and femur heads after a course of corticosteroid pulse therapy in May 2015. This case is interesting not only because the patient developed aseptic necrosis of the femoral, as well as humeral, heads, but also because the patient received stem-cell therapy after an intensive course of corticosteroids as a recommended up-to-date therapy to treat this complication of pulse therapy.