Connection Between Ulcerative Colitis and Avascular Necrosis: Unveiling the Relationship
In the world of ulcerative colitis (UC), a chronic inflammatory bowel disease, the use of corticosteroids such as prednisone can offer temporary relief from flare-ups. However, a growing body of evidence suggests that long-term use of these powerful drugs can lead to several complications, including avascular necrosis (AVN).
Avascular necrosis is a condition that causes bone tissue death due to a lack of blood supply. It most often affects the hips, knees, shoulders, ankles, and smaller joints like the wrist. While it is a recognized, though less common, complication of prolonged corticosteroid use, it is often underreported, with only 59% of radiology reports from people with inflammatory bowel disease (IBD) commenting on the presence of AVN.
A 2019 study in the Journal of Clinical Rheumatology estimated that an estimated percentage of people who use corticosteroids in the long term develop AVN. Another study in Gastroenterology Research and Practice found that of people with UC developed AVN in the hips. The longer a person uses corticosteroids, the higher their risk of developing AVN, with the risk increasing with higher doses and prolonged use.
People with UC and a prior joint disease, such as arthritis, have a 3-fold higher chance of having AVN compared to those without the joint disease. However, it is possible for people with UC to develop AVN without ever taking steroid medication, with these cases often having a history of joint diseases.
In UC patients, steroids used for treatment may cause higher cholesterol levels, potentially reducing blood flow around the body and to the bones. This, in turn, can lead to AVN.
While there is no cure for AVN, treatments can help reduce pain, restore function, and prevent further damage. If diagnosed and treated early, treatment may help prevent further damage to the joints and restore function. If a person with UC uses corticosteroids, a doctor will likely closely monitor for signs of bone damage and suggest alternative treatments to prevent potential joint damage caused by AVN.
It's important to note that corticosteroids are not the only treatment option for UC. They are not as frequently used in people with UC as they are in people with other types of IBD, such as Crohn's disease. Budesonide, a steroid with more targeted intestinal release, tends to have fewer systemic side effects and a lower risk of AVN compared to systemic corticosteroids but is still not free from side effects, especially with prolonged use.
In summary, avascular necrosis is one of several significant long-term complications related to corticosteroid therapy in ulcerative colitis. This highlights the importance of cautious use and preference for steroid-sparing treatments when possible. Common causes of AVN include alcohol misuse, joint injuries, other conditions, and long-term steroid use. The best way to reduce the risk of AVN is to avoid steroid use or use it for only short periods of time.
- Corticosteroids like prednisone, used in the treatment of ulcerative colitis (UC), offer temporary relief from flare-ups, but extended use can result in avascular necrosis (AVN).
- AVN is a bone tissue death condition caused by a lack of blood supply, primarily affecting hips, knees, shoulders, ankles, and smaller joints like the wrist.
- In radiology reports from people with inflammatory bowel disease (IBD), AVN is underreported, with only 59% of reports commenting on its presence.
- A 2019 study in the Journal of Clinical Rheumatology estimated the percentage of people using corticosteroids long-term who develop AVN.
- Another study in Gastroenterology Research and Practice found that a specific percentage of people with UC developed AVN in the hips.
- The risk of developing AVN increases with longer use, higher doses, and prolonged use of corticosteroids.
- People with UC and a prior joint disease have a 3-fold higher chance of having AVN compared to those without the joint disease.
- AVN can also develop without steroid medication use in UC patients, often with a history of joint diseases.
- Steroids used for UC treatment may cause increased cholesterol levels, potentially reducing blood flow around the body and to the bones, leading to AVN.
- Treatments for AVN can help reduce pain, restore function, and prevent further damage, but early diagnosis and treatment are essential.
- In UC patients, alternatives to corticosteroids should be considered when possible due to their significant long-term complications like AVN.
- Budesonide, a steroid with targeted intestinal release, has fewer systemic side effects and a lower risk of AVN compared to systemic corticosteroids, but it's not completely free from side effects, especially with prolonged use.
- Besides long-term steroid use, other causes of AVN include alcohol misuse, joint injuries, other conditions, and medical-conditions like chronic kidney disease, COPD, type-2-diabetes, cancer, respiratory-conditions, digestive-health, eye-health, hearing, mental-health, skin-care, and neurological-disorders.
- To reduce the risk of AVN, it's best to avoid steroid use or use it for only short periods of time, and a focus on nutrition, fitness-and-exercise, skin-care, and healthy lifestyle choices can help manage UC and other chronic diseases like multiple-sclerosis, migraine, and rheumatoid-arthritis.
