Osteonecrosis of both knees in a woman with Crohn's disease

Spontaneous bilateral avascular necrosis of knees and hip leading to early bilateral total hip arthroplasty: a case report of an 18-year-old man recently diagnosed with Crohn's disease

Avascular necrosis (AVN) is linked to considerable morbidity, resulting in severe pain and functional impairment. Herein, for the first time, we reported an 18-year-old patient with Crohn's disease during the remission phase under Azathioprine therapy who presented with articular pain. Although no underlying risk factors, the patient was diagnosed with severe AVN of the bilateral femoral head and both knees simultaneously following pain in involved areas. This case highlights the importance of demand multidisciplinary approach to chronic disease. Moreover, clinicians should be aware of articular manifestations in IBD patients to diagnose and treat these conditions as soon as possible. Patients should be evaluated for their psychologic, gastrointestinal, and extra-gastrointestinal comorbidities during each follow-up visit.

Osteonecrosis in Inflammatory Bowel Disease: Clinical Features, Risk Factor Analysis, and Outcomes

BACKGROUND

Avascular necrosis (AVN) is a known adverse event associated with corticosteroid (CS) usage. Inflammatory bowel disease (IBD) is often treated with a CS for induction of remission. We sought to describe clinical features and outcomes of IBD patients with AVN.

METHODS

In this retrospective, single-center, case-control study, patients with IBD who had a diagnosis of osteonecrosis, aseptic necrosis, or AVN from 1976 to 2009 were included, and each was matched with up to 2 controls (IBD but no AVN) on age, sex, IBD subtype, geographic area of residence, and date of IBD diagnosis. We abstracted risk factor data from the medical records. Conditional logistic regression was performed accounting for minor differences in age and date of first IBD visit to assess the relationship between putative risk factors and AVN, expressed as odds ratio and 95% confidence interval.

RESULTS

Eighty-five patients were diagnosed with IBD-AVN and were matched with 163 controls. The mean age at AVN diagnosis was 47.5 years. AVN was diagnosed a median of 12.2 years after IBD diagnosis, and the control group was followed for a median of 15 years after IBD diagnosis to ensure that they did not have AVN. Ten percent of patients with AVN did not have any CS exposure. History of arthropathy or estrogen use in Crohn's disease and use of CS, osteoporosis, and history of arthropathy in ulcerative colitis were significantly associated with AVN.

CONCLUSIONS

Most patients with IBD-AVN had multifocal involvement. Most had received CS, but many patients had other risk factors including arthropathy.

Clinical effects of comfort nursing in perianal abscess patients with postoperative pain

AIM

To evaluate the clinical effects of comfort nursing in patients with perianal abscess.

METHODS

Ninety perianal abscess patients with postoperative pain treated at our hospital were selected and divided into either a control group to receive routine nursing care alone or a study group to receive routine nursing care plus comfort nursing, with 45 cases in each group. Pain, anxiety and sleep quality of the two groups were compared between the two groups.

RESULTS

The numeric pain rating scale scores at different time points in the study group were significantly lower than those in the control group (t = 9.67, 13.53, 15.83, and 10.46, P < 0.05). The self-rating anxiety scale score were significantly lower in the study group than in the control group (t = 2.31, -18.04, P < 0.05); and the Pittsburgh sleep quality index were also significantly lower in the study group than in the control group (t = 9.47, P < 0.05).

CONCLUSION

The application of comfort nursing is helpful to reduce postoperative pain, relieve anxiety, and improve sleep quality in patients with perianal abscess.