Short-term outcome of painful bone marrow oedema of the knee following oral treatment with iloprost or tramadol: results of an exploratory phase II study of 41 patients

Mayerhoefer, Marius E.; Kramer, Josef; Breitenseher, Martin; Norden, Cornelia; Vakil-Adli, Anosheh; Hofmann, S.; Meizer, R; Siedentop, Harald; Landsiedl, F; Aigner, N

doi:10.1093/rheumatology/kem172

Cited by 41 publications

(35 citation statements)

References 33 publications

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“…Guerra and Steinberg described the distinguishing features of RMO and AVN, concluding that, although these are separate disease entities and have different risk factors, there are several similar characteristics in the early stages of the disease (6). For AVN the hypothesis has been proposed that implicates the disturbance of blood flow to the bone associated with hypofibrinolysis, and small clinical trials with vasomodulatory drugs such as prostacyclin analogue are under way (7).…”

Section: Discussionmentioning

confidence: 99%

Regional migratory osteoporosis in a patient with ankylosing spondylitis

Straten¹,

Franssen²,

Broeder³

et al. 2009

Scandinavian Journal of Rheumatology

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We report the first case of regional migratory osteoporosis (RMO) in a patient with ankylosing spondylitis (AS). This middle-aged man suffered from an acute onset of knee pain that increased on weight bearing, followed by ankle pain. The diagnosis of RMO was confirmed using magnetic resonance imaging (MRI), after exclusion of other causes of knee pain. MRI revealed a large area of bone marrow oedema without a zone of demarcation or subchondral fracture with a demonstration of shifting marrow oedema on the follow-up MRI scan from the medial femur condyl to the tibia plateau lateral and then to the distal tibia epiphysis. Treatment with the bisphosphonate ibandronate, however, was unsuccessful. RMO is characterized clinically by migrating arthralgia of the weight-bearing joints of the lower limbs, mainly in middle-aged males. Although the aetiology is unknown, the pathophysiology of RMO seems to be closely related to transient osteoporosis of the hip (TOH), which has been considered a reversible stage of avascular necrosis of the hip (AVN). There is no causal treatment for RMO. Avoidance of weight bearing and use of analgesics are effective in reducing symptoms. The combination of RMO and AS yielded diagnostic difficulties, as the clinical picture and the marrow oedema seen on MRI could be attributed to several AS-related causes such as enthesitis, early stadium of arthritis, osteonecrosis, or sterile osteomyelitis.

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Section: Discussionmentioning

confidence: 99%

Regional migratory osteoporosis in a patient with ankylosing spondylitis

Straten¹,

Franssen²,

Broeder³

et al. 2009

Scandinavian Journal of Rheumatology

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“…A randomized study compared iloprost (n ¼ 21, group 1) with tramadol (n ¼ 20, group 2). 42 The treatment duration was 4 weeks. The analgesic effect of iloprost and tramadol was similar.…”

Section: Treatmentsmentioning

confidence: 99%

“…Bone marrow edema regression on MRIs was more pronounced with iloprost treatment. 42 Iloprost has been studied in secondary avascular necrosis and found to decrease pain in the earlier phases of the disease but not preventing long-term progression to joint replacement. 43,44 Although not studied in SIF or RDO, VEGF has been studied in OA.…”

Section: Treatmentsmentioning

confidence: 99%

Circulation in Rapid Hip and Knee Bone Destruction

Nelson

2017

J Hip Surg

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In the hip and knee, the term subchondral insufficiency fracture has been used to describe a focal bone response associated with sudden onset of joint pain, older age, focal osteoporosis, and progression to joint replacement in some cases. Rapidly developing osteoarthritis of the hip is also associated with sudden onset of severe pain, and it usually progresses to larger areas of bone resorption with progression to joint replacement. The literature relative to these three conditions was reviewed focusing on patient demographics, imaging, osteoporosis, associated comorbidities, cytokine changes, similar vascular disorders in other joints, and attempts at nonsurgical treatment. These conditions predominate in, but are not restricted to, individuals who are older than 50, have physical joint abnormalities, are not systemically osteoporotic, and have had no apparent trauma. The biochemical and genetic mechanisms for hip and knee insufficiency fractures is not clear. Although there are reports of hip subchondral insufficiency fractures associated with rapidly developing osteoarthritis of the hip, it is not clear whether all cases are preceded with insufficiency fractures. There is insufficient information on the fracture healing mechanism of insufficiency fractures, and the relationship to vascularity and biochemical imbalance is poorly understood. It is concluded that there are large gaps in the knowledge of biochemical and other mechanisms that might link these conditions. This knowledge may influence nonsurgical treatment strategies.

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“…32 Forty-one patients with painful ischemic or mechanical bone edema (BME) of the knee were enrolled in a double-blind, randomized controlled study testing oral iloprost (group 1) vs. tramadol (group 2). 32 Forty-one patients with painful ischemic or mechanical bone edema (BME) of the knee were enrolled in a double-blind, randomized controlled study testing oral iloprost (group 1) vs. tramadol (group 2).…”

Section: Prostacyclin Analogmentioning

confidence: 99%