Avascular necrosis of the femoral head in multiple sclerosis

Objective: Corticosteroid (CS) therapy is widely used as the standard treatment for acute exacerbations of multiple sclerosis (MS). Avascular necrosis (AVN) of the femoral head is one of the long–term complications related to CS therapy. Our study aims to investigate the association between annual and cumulative doses of CS treatment and radiographic assessment of AVN of the femoral head in MS.
Material and Methods: One patient group and two control groups were formed. The study group consisted 60 MS cases treated with intravenous methylprednisolone (IVMP) and the 2 control groups consisted 22 MS patients (Control I) without CS treatment and 25 healthy controls (Control II). Sixty patients who underwent CS treatment were divided into 3 subgroups of 20 cases each, treated with either IVMP only, IVMP and interferon, and IVMP and glatiramer acetate (GA). Neurological examinations and demographic data of all cases were recorded. The presence of AVN of femoral head in patient and control groups was evaluated using magnetic resonance imaging and Ficat staging system.
Results: Avascular necrosis (AVN) of femoral head was observed in 4 (6.7%) MS patients who were treated with CS. The mean annual CS dose was 8.07 g and mean cumulative dose was 31 gr. There was a significant but no statistical difference, in annual and cumulative IVMP doses between patients who have and don’t have AVN of femoral head (p=0.085 and p=0.246, respectively).
Conclusion: Our all data support the idea that annual dose of CS may increase AVN of femoral head development in MS patients. It is important to evaluate the CS-treated MS patients with MRI in this respect, due to the possible treatment of early-stage AVN of femoral head.

Multipl sklerozda femur baþý avasküler nekrozu

Amaç: Kortikosteroid (KS) tedavisi multipl skleroz (MS) akut ataklarýnda yaygýn olarak kullanýlan standart bir tedavi yöntemidir. Femur baþý avasküler nekrozu (AVN) KS tedavisine baðlý geliþen uzun dönem komplikasyonlardan biridir. Çalýþmamýzda femur baþý AVN’ un MS hastalarýnda görülme sýklýðý ile uygulanan yýllýk ve kümülatif KS miktarý ile olan iliþkisi araþtýrýlmýþtýr.
Gereç ve Yöntemler: Çalýþmamýzda MS polikliniðinden takipli intravenöz metilprednizolon (IVMP) tedavi almýþ 60 MS tanýlý hasta grubu ile IVMP tedavisi almamýþ 22 MS hasta (Kontrol I) ile 25 saðlýklý olgudan (Kontrol II) oluþan iki kontrol grubu oluþturuldu. KS tedavisi alan 60 hasta sadece IVMP, IVMP ve interferon, IVMP ve Glatiramer asetat (GA) kullanan 20’þer olguluk üç alt gruba ayrýldý. Tüm
olgularýn nörolojik muayeneleri ve tüm demografik verileri kaydedildi. Hasta ve kontrol gruplarýnda femur baþý AVN varlýðý, manyetik rezonans görüntüleme (MRG) ile Ficat Evreleme sistemi kullanýlarak deðerlendirildi.
Bulgular: Femur baþý AVN sadece KS tedavisi alan 4 MS hastasýnda (%6.7 oranýnda) gözlendi. Hastalarýn ortalama yýllýk KS dozu 8.07 gr, ortalama kümülatif KS dozu 31 gr bulundu. Femur baþý AVN olan hastalar ile olmayan hastalar arasýnda yýllýk ve kümülatif IVMP doz miktarlarýnda belirgin bir fark gözlenmekle birlikte istatistiksel anlamlýlýk saptanmadý (sýrasýyla p=0.085 ve p=0.246).
Sonuç: Elde ettiðimiz veriler MS hastalarýnda femur baþý AVN geliþiminin KS yýllýk doz miktarý ile artabileceði fikrini desteklemektedir. Femur baþý AVN’de erken evrede taný ile tedavinin mümkün olmasý nedeniyle özellikle KS tedavisi alan MS hastalarýnýn bu açýdan da takibi ve MRG ile birlikte deðerlendirilmeleri önem kazanmaktadýr.