Extremely early stage osteonecrosis of the femoral head in a patient with hip pain secondary systemic steroid pulse therapy for Vogt-Koyanagi-Harada syndrome: A case report

Kuroda, Yutaka; So, KF; Goto, Koji; Matsuda, Shuichi

doi:10.1016/j.ijscr.2016.06.003

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…But the amount of these cells were less than fat cells and MRI may not reflect the lesion of femoral head. MRI scan only gave the osteonecrosis signal after fat cell death (12–48 hours), when some pathologic changes appeared, such as disorder of bone trabecula, pimelosis of marrow cavity, fatty degeneration and necrosis of osteocyte and so on [ 9 ]. Through MRI and observation on histopathology, we found that joint space of femoral heads got wide slightly and had a little patchy hyperintensity round 3 weeks later.…”

Section: Discussionmentioning

confidence: 99%

“…At present, early diagnosis of SANFH depended on magnetic resonance imaging (MRI) scan [ 6 ]. However, the MRI only diagnose osteonecrosis after fat cell death 12–48 hours, when some pathologic changes were already generated, such as structural disorder of bone trabecula, pimelosis of marrow cavity, fatty degeneration and necrosis of osteocyte and so on [ 7 – 9 ]. Hence, it was meaningful to screen out risk factors of femoral head necrosis, monitor and intervene as early as possible, and prevent the emergence of early pathologic changes.…”

Section: Introductionmentioning

confidence: 99%

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A metabolomic study on early detection of steroid-induced avascular necrosis of the femoral head

Ren

Shao

et al. 2018

Oncotarget

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The early and accurate diagnosis of steroid-induced avascular necrosis of the femoral head (SANFH) is appealing considering its irreversible progression and serious consequence for the patients. The purpose of this study was to investigate the metabolic change of SANFH for its early detection. Two stages were designed in this study, namely discovery and verification. Except the biochemical index anomaly and the accidental death, 30 adult healthy adult Japanese white rabbits were used for screening out the potential metabolites in discovery experiment and 13 rabbits were used in verification experiment. The femoral heads were assessed with magnetic resonance imaging and transmission electron microscopy. The metabolomic profiling of serum samples were analysis by UHPLC-MS/MS. Metabolomic cluster analysis enable us to differentiate the rabbits without and with injection of the glucocorticoid in 1 week even when there is no obvious abnormal symptom in behaviors or imaging diagnosis. The majority of differential metabolites were identified as phospholipids which were observed significant change after injection of glucocorticoid in 1, 2, 3 weeks. And the results obtained in verification experiment of 6 weeks showed that these differential metabolites exhibited consistent trends in late progression with that in early-stage. At the end of 6 weeks the damage of SANFH could be verified by pathological imaging. Therefore the finding of serum metabolite profile links to the progression of SANFH and provides the potential of early detection of SANFH.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A metabolomic study on early detection of steroid-induced avascular necrosis of the femoral head

Ren

Shao

et al. 2018

Oncotarget

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“…Patients with ONFH following VKH syndrome could be diagnosed early and successfully treated by joint-preserving regenerative therapy. 25 …”

Section: Discussionmentioning

confidence: 99%

“…MRI is considered the most accurate test and is both highly sensitive and highly specific for early ONFH without symptoms. 5 – 7 , 10 , 25 …”

Section: Discussionmentioning

confidence: 99%

Bilateral osteonecrosis of the femoral head associated with corticosteroid therapy for alopecia areata: a case report and review of the literature

Kuroda

Kawai

Goto

et al. 2018

TCRM

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Corticosteroids have been widely used for the treatment of various inflammatory diseases because they provide an acute response of immunosuppression. Numerous side effects of corticosteroids have also been known, with varying degrees of severity. Osteonecrosis of the femoral head (ONFH) is a rare and serious complication that directly inhibits walking because of femoral head collapse. However, sometimes, clinicians who consider that corticosteroids are required for primary disease do not recognize steroid-induced ONFH. The final stage of ONFH is severe osteoarthritis, requiring total hip arthroplasty. We describe a 23-year-old woman with bilateral ONFH after corticosteroid treatment for alopecia areata (AA). She was administered several intralesional corticosteroid injections to the scalp and repeated systemic corticosteroid therapy for extensive AA. While undergoing therapy, she lost her balance and complained of right groin pain when standing. The patient was subsequently diagnosed with bilateral ONFH. She recovered from AA, but she complained of persistent right hip pain, which subsequently required total hip arthroplasty. We would like to emphasize that patients on corticosteroid therapy for any common disease should be considered as having a potential risk for ONFH. An early stage detection of ONFH is crucial for its treatment. MRI evaluation warrants a higher level of accuracy in early diagnosis of ONFH for the opportunity to undergo joint-preservation surgery in patients with ONFH.

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“…In recent years, the number of osteoarthritis has risen and an increasing number of individuals have been clinically diagnosed with the condition, which presents a serious threat to human health and quality of life ( 4 , 5 ). Osteonecrosis of the femoral head is a specific type of osteoarthritis that significantly affects the patient's ability to move and exhibits the most serious degeneration of the joints among osteonecrosis diseases ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Bone morphogenetic protein-2 exhibits therapeutic benefits for osteonecrosis of the femoral head through induction of cartilage and bone cells

2018

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Osteonecrosis of the femoral head is an orthopedic disease caused by femoral head damage or insufficient blood supply, which leads to the death of bone cells and bone marrow. Osteonecrosis of the femoral head leads to changes in the structure of the femoral head, femoral head collapse and joint dysfunction. Bone morphogenetic protein-2 (BMP-2) exhibits beneficial effects on bone formation, repair and angiogenesis at the femoral head. In the present study, the therapeutic effects of recombinant human BMP-2 containing an Fc fragment (rBMP-2/Fc) were investigated on a steroid induced mouse model of osteonecrosis of the femoral head. Bone cell viability was used to determine the in vitro effects of rBMP-2/Fc. The therapeutic efficacies of rBMP-2/Fc on mice with osteonecrosis of the femoral head were evaluated using clinical arthritis scores. The expression levels of inflammatory factors in the mice were analyzed by reverse transcription-quantitative polymerase chain reaction. Histological analysis was used to evaluate the effects of rBMP-2/Fc on the femoral head. The results revealed that rBMP-2/Fc treatment significantly increased the IL-6, IL-10, vascular endothelial growth factor and macrophage colony-stimulating factor expression levels in synovial cells compared with the control group (P<0.01). Furthermore, it was observed that rBMP-2/Fc significantly improved the viability and growth of synovial cells (P<0.01) through the nuclear factor (NF)-κB signaling pathway. Treatment with rBMP-2/Fc significantly decreased receptor activator of NF-κB ligand expression levels. Furthermore, in vivo experiments demonstrated that rBMP-2/Fc treatment markedly relieved the arthralgia and damage caused by osteonecrosis of the femoral head. In conclusion, rBMP-2/Fc treatment may be beneficial for articular cartilage repair by the upregulation of angiogenesis factors through the down regulation of the NF-κB signaling pathway in mice with osteonecrosis of the femoral head. This preclinical data suggests that rBMP-2/Fc may be a promising novel agent for treatment of osteonecrosis of the femoral head.

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Extremely early stage osteonecrosis of the femoral head in a patient with hip pain secondary systemic steroid pulse therapy for Vogt-Koyanagi-Harada syndrome: A case report

Cited by 6 publications

References 19 publications

A metabolomic study on early detection of steroid-induced avascular necrosis of the femoral head

A metabolomic study on early detection of steroid-induced avascular necrosis of the femoral head

Bilateral osteonecrosis of the femoral head associated with corticosteroid therapy for alopecia areata: a case report and review of the literature

Bone morphogenetic protein-2 exhibits therapeutic benefits for osteonecrosis of the femoral head through induction of cartilage and bone cells

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