iloprost and Arthralgia

The purpose of this study was to assess the efficacy of the vasoactive drug iloprost in Bone Marrow Edema Syndrome (BMES) and to compare it to the results of a control group treated by core decompression.. 38 hips (36 patients) with BMES in the femoral head were investigated. In group A, 18 hips (17 patients; mean age 49 years) were treated with iloprost, a vasoactive drug that dilates arterioles and venules, reduces capillary permeability and suppresses platelet aggregation. The therapy comprised a series of five infusions with 20 microg iloprost over 6 hours on 5 consecutive days. Weight bearing was reduced for up to 3 weeks, depending on the severity of symptoms. In group B, 20 hips (19 patients; mean age 41 years) underwent surgical core decompression of the femoral head followed by 6 weeks of partial weight bearing. Both groups were evaluated clinically, radiographically and by MRI.. In group A, one patient had to discontinue therapy on the first day because of severe headache. In the remaining patients the Harris Hip Score (HHS) improved from a mean of 64.7 points (range 44-89) before therapy to 97.0 points (83-100) after 3 months. MRI controls showed complete remission in all hips. In group B, the preoperative HHS improved from 53.7 points (31-82) to 95.1 points (39-100) after 3 months. MRI controls showed complete remission of BMES in 14 hips, residual focal bone marrow edema in four hips and a small osteonecrotic area in two hips. In both groups the high level of clinical recovery was maintained at the last examination after a mean follow up of 11 months in group A and 12 months in group B.. The parenteral application of iloprost can achieve equal or better results in the treatment of bone marrow edema syndrome of the hip compared to core decompression.

Topics: Adult; Aged; Arthralgia; Bone Marrow Diseases; Decompression, Surgical; Edema; Epoprostenol; Female; Femur Head; Humans; Iloprost; Magnetic Resonance Imaging; Male; Middle Aged; Prognosis; Syndrome; Treatment Outcome; Vasodilator Agents

Bone marrow oedema (BMO) is a multifactorial condition. The conservative treatment options include immobilisation of the affected region and systemic intravenous iloprost therapy. Whereas many studies confirm the positive effect of iloprost therapy in larger joints, e.g. knee and hip, there have been few studies of BMO in smaller areas such as the ankle joint or midfoot. The purpose of this study is to show that treatment with iloprost leads to positive long-term outcomes for BMO of the foot and ankle.. Twenty-three patients with BMO of the ankle joint or midfoot, Association Research Circulation Osseous (ARCO) stages 1-2, were included in this study. A questionnaire was used to record the Ankle-hindfoot, Kaikkonen, SF-36 and VAS scores before and after iloprost therapy. In addition, all patients underwent MRI for radiological follow-up monitoring 3 months after treatment.. A significant improvement in function based on the ankle-hindfoot and Kaikkonen scale was demonstrated after iloprost therapy. In 22 patients, follow-up MRI after 3 months showed complete regression of the oedema.. 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.

Topics: Ankle Joint; Arthralgia; Bone Marrow Diseases; Edema; Female; Foot Joints; Humans; Iloprost; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Middle Aged; Pain Measurement; Retrospective Studies; Vasodilator Agents

Bone marrow edema syndrome of the femoral head in pregnant women is a rare disease resulting in disabling coxalgia, beginning in the last 3 months of pregnancy and persisting for several months after parturition. The parenteral administration of the vasoactive drug iloprost constitutes a new approach to the treatment of painful bone marrow edema syndrome of the hip of pregnant women. Six postpartal women (8 hips) with bone marrow edema syndrome of the femoral head were treated with iloprost followed by 3 weeks of partial weight-bearing. Relief from pain, restoration of functional capacity, and normalization of the MRI signal pattern were rapidly achieved, thus avoiding the need for surgical intervention. As the substance is contraindicated in pregnancy, therapy may begin only some days after parturition, with a short discontinuation in breastfeeding.

Topics: Adult; Arthralgia; Bone Marrow Diseases; Diagnosis, Differential; Dose-Response Relationship, Drug; Edema; Female; Femur Head; Follow-Up Studies; Hip Joint; Humans; Iloprost; Injections, Intravenous; Magnetic Resonance Imaging; Pilot Projects; Postpartum Period; Pregnancy; Pregnancy Complications; Prospective Studies; Recovery of Function; Syndrome; Treatment Outcome; Vasodilator Agents

To report the case of a child diagnosed with polyarteritis nodosa (PAN) that was unresponsive to conventional treatment alone but improved with the addition of iloprost and bosentan to her drug regimen.. A 3-year-old girl who had been diagnosed with PAN was referred to our hospital from another region. With conventional treatment of high doses of a corticosteroid and cyclophosphamide, her condition resolved. Six months later, our patient had a relapse that required hospital admission. In this second hospital stay, some cutaneous lesions evolved into digital necrosis. Offlabel therapeutic alternatives, including a single dose (2 g/kg) of intravenous immunoglobulin (IVIG), intravenous iloprost 2 ng/kg/min over 6 h for 5 days and, approximately 4 wk later, oral bosentan 37.25 mg twice daily for 4 wk followed by 62.5 mg twice daily for 8 wk, were added to the conventional regimen to treat the serious cutaneous manifestations. Her fingers improved very slowly, and she was discharged on gradually tapered doses of oral corticosteroids, bosentan, and monthly pulsed injections of cyclophosphamide. The digital necrosis and other cutaneous lesions had resolved completely 6 months after the second discharge.. The dosages of IVIG and iloprost were based on those used for PAN, Raynaud's phenomenon, and digital necrosis in children. The use of bosentan for vasculitis had not been reported in children before the treatment of our patient, so its dosage was based on that used to produce vasodilation in children with pulmonary hypertension.. Digital necrosis and cutaneous manifestations not resolved with conventional PAN treatment improved within 5 days with iloprost and 12 weeks with bosentan.

Topics: Anti-Inflammatory Agents; Antihypertensive Agents; Arthralgia; Azathioprine; Bosentan; Child, Preschool; Cyclophosphamide; Female; Fever; Humans; Iloprost; Immunoglobulins, Intravenous; Immunosuppressive Agents; Methylprednisolone; Polyarteritis Nodosa; Sulfonamides; Vasodilator Agents