The Journal of Bone and Joint Surgery -British Volume publishes a study showing a causal link between treatment for SARS and joint disease. The study conducted a review of over 100 patients who were treated with corticosteriods for SARS during the first outbreaks in China in 2003, of which nearly 40% went on to develop osteonecrosis. The study has enabled a causal link between the amount of steroid given and the severity of joint disease to be positively established for the first time, due in part to the large sample size.
Osteonecrosis is a condition caused when the blood supply to the bones is poor or cut off completely, which causes them to die. The condition can be devastating when it affects the hip, knee, shoulder or ankle, and in later stages can mean total joint replacement. Diagnosis in this case was by MRI scans which can detect the disease even at early stages. It was clear from the scans conducted that 43 patients ‘with osteonecrosis received significantly higher cumulative and peak’ doses of corticosteroids.
The study’s authors recommend therefore that in future SARS patients should be treated with lower doses since ‘the number of osteonecrotic lesions was directly related to the dosage’ and that ‘a peak dose of more than 200mg in a cumulative methylprednisolone-equivalent dose of more than 4000mg, is a significant risk factor’ for the development of joint disease.