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13 - Avascular necrosis of the femoral head in multiple sclerosis
Dilvin Gökçe, Şenay Aydın, İlknur Cantürk Aydın, Reyhan Gürer, Nihal Işık
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 longterm 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 dont 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.
Keywords: Avascular necrosis of the femoral head, corticosteroid treatment, multiple sclerosis
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