Multifocal osteonecrosis in a patient with anamnestic ulcerative colitis. Is there a relationship with the disease and the use of glucocorticoids twenty years before? A brief review of the literature.

In 2013 a 40 year old man came to visit in our Rheumatology Unit because of a recent bilateral shoulder and hip pain. He had been treated from 1990 to 2000 with Cyclosporin A and Sulfasalazyn because of an ulcerative colitis which was completely in remission from 2000 . Glucocorticoids at the mean daily dose of 50 mg were administered only in the first period (1990-92). X-plain rays showed a suspicious multifocal osteonecrosis of both femoral and humeral heads. Magnetic Resonance confirmed the diagnosis (stage III and IV following Ficat and Arlet’s criteria). The patient was treated with a cycle of hyperbaric oxygen therapy, with two cycles of intravenous clodronate and with a 2-month cycle of teriparatide.

Systematic review: The safety and efficacy of hyperbaric oxygen therapy for inflammatory bowel disease.

Hyperbaric oxygen therapy (HBOT) provides 100% oxygen under pressure, which increases tissue oxygen levels, relieves hypoxia and alters inflammatory pathways. Although there is experience using HBOT in Crohn’s disease and ulcerative colitis, the safety and overall efficacy of HBOT in inflammatory bowel disease (IBD) is unknown. To quantify the safety and efficacy of HBOT for Crohn’s disease (CD) and ulcerative colitis (UC). The rate of adverse events with HBOT for IBD was compared to the expected rate of adverse events with HBOT. MEDLINE, EMBASE, Cochrane Collaboration and Web of Knowledge were systematically searched using the PRISMA standards for systematic reviews. Seventeen studies involving 613 patients (286 CD, 327 UC) were included.