Multiple Joint Osteonecrosis in a Patient on Long-term Intranasal Corticosteroids

Yousef, Mohamed; Ayers, David C.

doi:10.5435/jaaosglobal-d-20-00095

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…This concept has been extrapolated into a “multiple-hit” theory by which corticosteroids alter bone homeostasis, injure bone cells, impair blood flow, and suppress bone cell precursors in susceptible patients” 3,13 . It is well known that high-dose long-term corticosteroid use is associated with osteonecrosis, but osteonecrosis can also develop after short-term, low-dose oral treatment, intra-articular injection, or even inhalational use for conditions such as allergic rhinitis or asthma 29,30 . A dose-response relationship was confirmed for the development of osteoporosis, but not for osteonecrosis 30 .…”

Section: Osteonecrosis Versionmentioning

confidence: 99%

Osteonecrosis

Lawhorne¹,

Kortyna²

2022

JBJS Journal of Orthopaedics for Physician Assistants

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Section: Osteonecrosis Versionmentioning

confidence: 99%

Osteonecrosis

Lawhorne¹,

Kortyna²

2022

JBJS Journal of Orthopaedics for Physician Assistants

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“… 22. Yousef et al20 reported a case of bilateral knee osteonecrosis following long-term intra-nasal steroid therapy. Various genes also contribute to osteonecrosis, which include eNOS, PAI-1, VEGF, and ApoA.…”

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confidence: 99%

Osteonecrosis of the Knee: The Unintended Consequence of Steroid Abuse

Sondur,

VJ,

Das

2024

Clin Med Res

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The anti-inflammatory and immunosuppressive properties of steroids allow their use in a wide variety of rheumatological diseases, asthma, inflammatory bowel disease, cancer therapy, and severe viral infections. Though life-saving or organ-saving, long-term clinical use leads to a vast array of complications. Osteoporosis is the most common orthopedic side effect of steroid abuse, while osteonecrosis is a rare occurrence. The risk of osteonecrosis appears to be dose and duration dependent, but several patient factors also play a major role and usually affect the femoral head followed by the knee joint. The long-term effects of steroids must be explained to all patients on therapy, but this risk is missed in individuals who abuse steroids for recreational or performanceenhancing purposes. We describe a male, aged 29 years, who presented with dull aching bilateral knee pain of 2-years' duration after a long-term steroid abuse for weight and muscle mass gain. Radiological and magnetic resonance imaging studies confirmed osteonecrosis of femoral and tibial condyles and secondary degenerative arthritis of the knee joint. Prompt suspicion, early diagnosis, and intervention in osteonecrosis of knee joints, and termination of steroids may reverse the pathology and prevent progression of disease.

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Fluticasone propionate

2021

Reactions Weekly

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Multiple joint osteonecrosis: case reportA 58-year-old woman developed multiple joint osteonecrosis during treatment with fluticasone propionate for allergic rhinitis [dosage and time to reaction onset not stated].The woman had a history of hypertension, depression, hypothyroidism and allergic rhinitis. Her regular medications included intranasal fluticasone propionate [Flonase] two puffs each nostril twice a day for several years along with other co-medications. She presented with a 9-week history of gradual knee pain. Upon initial examination, the mild degenerative joint disease was noted. Hence, she received treatment with naproxen and four weeks of physiotherapy was suggested. However, no improvement was noted in her condition. She continued to have knee pain. MRI findings of the left leg revealed a large area of acute bone marrow oedema with abnormal signal intensity in the medial tibial plateau consisting of an insufficiency fracture. For protected weightbearing, she started to use a walker. MRI findings of the right leg showed similar findings to the left leg. Additionally, a linear T2-hyperintense signal was noted with bilateral subchondral sclerotic lesions.The woman was treated with ibuprofen, gabapentin, alendronic acid [alendronate] with physical therapy. After 8 weeks, her knee pain reduced; however, she started to have disabling pain in her left ankle. Hence, L5/S1 left radiculopathy was considered, and she was treated with transforaminal epidural steroid injection. However, the pain did not reduce. An MRI of the left ankle was performed; it showed extensive osteonecrosis with the talus and navicular bones. Further, imaging of knee showed progressive collapse of the medial tibial plateau with varus malalignment and secondary bilateral osteoarthritis with stage 4 disease progression. A multiple joint osteonecrosis was confirmed by bone histopathology, and was attributed to her long-term fluticasone propionate use. Hence, she was admitted and underwent staged bilateral total knee arthroplasty (TKA.) Post-TKA, significant improvement was noted in her condition. Later, her left ankle was treated with a solid ankle-foot orthosis. The osteonecrosis progressed secondary to the degenerative arthritis of the tibiotalar and subtalar joints [outcome not stated].

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Multiple Joint Osteonecrosis in a Patient on Long-term Intranasal Corticosteroids

Cited by 3 publications

References 22 publications

Osteonecrosis

Osteonecrosis

Osteonecrosis of the Knee: The Unintended Consequence of Steroid Abuse

Fluticasone propionate

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