Effects of intravenous iloprost therapy in patients with bone marrow oedema of the foot and ankle

Röhner, Eric; Zippelius, Timo; Steindl, David; Fussi, Jasmin; Perka, Carsten

doi:10.1007/s00590-013-1320-0

Cited by 18 publications

(34 citation statements)

References 22 publications

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“…Measures to shorten this natural history should initially be partial weight-bearing, immobilization, analgesics and anti-inflammatory medication. Additional treatment approaches include extracorporeal shock wave therapy, bisphosphonates, and iloprost [1,3,29,[110][111][112]. Regarding pharmaceutical therapy, we recommend zoledronate 5 mg IV as primary treatment and iloprost administered for a total dose of 180 µg IV over 5 days (day 1: 20 µg over 6-8 h; day 2-5: dose increase to 40 µg per day over 6-8 h).…”

Section: Bone Marrow Edema Syndrome (Bmes)mentioning

confidence: 99%

How We Manage Bone Marrow Edema—An Interdisciplinary Approach

Baumbach

Pfahler

Pozza

et al. 2020

JCM

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Bone marrow edema (BME) is a descriptive term for a common finding in magnetic resonance imaging (MRI). Although pain is the major symptom, BME differs in terms of its causal mechanisms, underlying disease, as well as treatment and prognosis. This complexity together with the lack of evidence-based guidelines, frequently makes the identification of underlying conditions and its management a major challenge. Unnecessary multiple consultations and delays in diagnosis as well as therapy indicate a need for interdisciplinary clinical recommendations. Therefore, an interdisciplinary task force was set up within our large osteology center consisting of specialists from internal medicine, endocrinology/diabetology, hematology/oncology, orthopedics, pediatrics, physical medicine, radiology, rheumatology, and trauma surgery to develop a consenus paper. After review of literature, review of practical experiences (expert opinion), and determination of consensus findings, an overview and an algorithm were developed with concise summaries of relevant aspects of the respective underlying disease including diagnostic measures, clinical features, differential diagnosis and treatment of BME. Together, our single-center consensus review on the management of BME may help improve the quality of care for these patients.

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Section: Bone Marrow Edema Syndrome (Bmes)mentioning

confidence: 99%

How We Manage Bone Marrow Edema—An Interdisciplinary Approach

Baumbach

Pfahler

Pozza

et al. 2020

JCM

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“…Another study by Meizer et al reported that on MRI, 20 patients showed complete normalization, four showed no change, and three showed worsening of the MRI pattern [13]. Claßen et al [20] and Röhner et al [6] have suggested that iloprost therapy is a safe and effective method in the treatment of AVN, particularly in patients with an early ARCO stage (stages I and II). Hörterer et al treated 42 ARCO stage I-III patients with BME of the foot and ankle and reported that the treatment resulted in a 60% pain and 80% edema reduction after three months [21]; however, the patients indicated having residual impairment after two years.…”

Section: Discussionmentioning

confidence: 99%

“…Insufficient osseous blood supply can result in BME and/or AVN. The prostacyclin analog iloprost is a treatment option used for improving bone blood perfusion [3][4][5][6][7][8][9]10]. Jäger et al administered iloprost therapy in 95 patients and reported that the pain levels decreased and the functional scores improved in all the patients.…”

Section: Discussionmentioning

confidence: 99%

“…All patients were administered an intravenous infusion of 20 μg/ml of iloprost (Ilomedin®, Bayer Schering, Berlin, Germany) in 500 ml of sodium chloride solution, given over a period six hours, on five consecutive days [3][4][5][6]9,10]. All patients were admitted to the hospital and monitored closely for possible adverse effects.…”

Section: Methodsmentioning

confidence: 99%

“…Treatment options are limited, including both conservative and surgical techniques [1]. Although numerous conservative techniques including pharmacological agents such as warfarin, enoxaparin, statins, bisphosphonates, and acetylsalicylic acid, and other treatment modalities including extracorporeal shock wave therapy (ESWT), hyperbaric oxygen therapy (HBOT), electro-stimulation, and pulsed electromagnetic field therapy (PEMFT) have been performed in the treatment of BMES, none of them has been shown to prevent the disease effectively and delay femoral head collapse, and some of them have been shown to have multiple side effects [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of Iloprost in the Treatment of Bone Marrow Edema

Tosun¹,

Uludağ²,

Demir³

et al. 2020

Cureus

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Background and objective Bone marrow edema (BME) is a rare condition caused by insufficient osseous blood supply and may result in severe pain that has adverse effects on patients' life. To date, various conservative treatments have been recommended for the treatment of BME, including analgesics, immobilization of the affected extremity, and iloprost infusion. The aim of this retrospective study was to investigate the effectiveness of parenteral iloprost therapy in the treatment of BME detected in different skeletal locations. Materials and methods This retrospective study included 23 patients (17 men and six women) with BME who were classified as stage I-III according to the Association Research Circulation Osseous (ARCO) classification. BME was localized to the proximal femur in 13 (56.5%), the distal femur in four (17.4%), tarsal bone in four (17.4%), and tibial plateau in two (8.7%) patients. The mean age of the patients was 46.7 years and all the patients were evaluated with the Visual Analog scale (VAS), Functional Mobility Scale (FMS), and MRI. Results A significant improvement was observed in the post-treatment VAS and FMS scores of all patients compared to their pre-treatment scores. Moreover, the edema regressed completely in 60.9% of the patients at three months of MRI control. No serious side effects were observed during the treatment in any of the patients. However, transient side effects including headache, arrhythmia, and flushing were observed in five patients. Conclusion The present study indicated that iloprost therapy is an effective and safe option in the treatment of BME patients, particularly in the reduction of severe pain that has adverse effects on patients' social life, regardless of ARCO staging. Moreover, this therapy could be particularly useful in reducing pain, improving functional recovery, and achieving complete regression of the edema on MRI in ARCO stage I-II patients.

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Klinische Aspekte der Knochenmarködeme: eine Literaturübersicht

Stojanovska¹,

Schirmer²

2022

J. Miner. Stoffwechs. Muskuloskelet. Erkrank.

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ZusammenfassungÜber das primäre Knochenmarködemsyndrom (KM-Ödemsyndrom) ist in der Literatur relativ wenig bekannt. Aufgrund dieser Übersichtsarbeit erscheint es sinnvoll, Klassifikationskriterien zu entwickeln, mit klarer Unterscheidung zwischen primärem und sekundärem KM-Ödemsyndrom. Auf dieser Basis können dann in der Folge Outcomeparameter besser definiert und validiert werden, um größere randomisierte, möglichst doppelblinde Studien sowohl für pharmakologische als auch nichtpharmakologische Therapieverfahren zu initiieren.

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Effects of intravenous iloprost therapy in patients with bone marrow oedema of the foot and ankle

Abstract: Based on the positive results of our study, we recommend treatment with iloprost for BMO of the upper ankle joint and foot at ARCO stages 1-2.

Cited by 18 publications

References 22 publications

How We Manage Bone Marrow Edema—An Interdisciplinary Approach

How We Manage Bone Marrow Edema—An Interdisciplinary Approach

Effectiveness of Iloprost in the Treatment of Bone Marrow Edema

Klinische Aspekte der Knochenmarködeme: eine Literaturübersicht

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