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Open Access Research article

Rationale for prostaglandin I2 in bone marrow oedema – from theory to application

Marcus Jäger13*, Frank Peter Tillmann2, Thomas S Thornhill3, Marcus Mahmoudi1, Dirk Blondin4, Gerd Rüdiger Hetzel2, Christoph Zilkens1 and Rüdiger Krauspe1

Author Affiliations

1 Department of Orthopaedics, Heinrich-Heine University Hospital Duesseldorf, Moorenstrasse 5, D-40225 Duesseldorf, Germany

2 Clinic for Nephrology and Rheumatology, Heinrich-Heine University Duesseldorf, Moorenstrasse 5, D-40225 Duesseldorf, Germany

3 Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA

4 Institute of Diagnostic Radiology, Heinrich-Heine University Duesseldorf, Moorenstrasse 5, D-40225 Duesseldorf, Germany

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Arthritis Research & Therapy 2008, 10:R120  doi:10.1186/ar2526

Published: 3 October 2008

Abstract

Introduction

Bone marrow oedema (BME) and avascular osteonecrosis (AVN) are disorders of unclear origin. Although there are numerous operative and non-operative treatments for AVN, pain management in patients with AVN remains challenging. Prostaglandins play an important role in inflammatory responses and cell differentiation. It is thought that prostaglandin I2 ([PGI2] or synonoma prostacyclin) and its analogues promote bone regeneration on a cellular or systemic level. The purpose of this study was to assess the curative and symptomatic efficacy of the prostacyclin analogue iloprost in BME and AVN patients.

Method

We are reporting on 50 patients (117 bones) affected by BME/AVN who were treated with iloprost. Pain levels before, during and 3 and 6 months after iloprost application were evaluated by a visual analogue scale (VAS). The short form(SF)-36 health survey served to judge general health status before and after treatment. Harris Hip Score (HHS) and Knee Society Score (KSS) were performed as functional scores and MRI and X-rays before and 3 and 6 months after iloprost application served as objective parameters for morphological changes of the affected bones.

Results

We found a significant improvement in pain, functional and radiological outcome in BME and early AVN stages after iloprost application, whereas patients with advanced AVN stages did not benefit from iloprost infusions. Mean pain level decreased from 5.26 (day 0) to 1.63 (6 months) and both HHS and KSS increased during follow-up. Moreover, the SF-36 increased from 353.2 (day 0) to 560.5 points (6 months). We found a significant decrease in BME on MRI scans after iloprost application.

Conclusions

In addition to other drugs, iloprost may be an alternative substance which should be considered in the treatment of BME/AVN-associated pain.