Mumbai: A new health complication arising from the treatment of Covid-19 has left the medical fraternity baffled after three confirmed cases of avascular necrosis (AVN) or death of bone tissues have been scientifically reported from Mumbai.
AVN has emerged as yet another debilitating condition after mucormycosis or black fungus affecting post-Covid patients. According to the Times of India report, doctors are worried that more cases are likely to appear in the next few months.
The common factor between mucormycosis and avascular necrosis is found to be the use of steroids, the only drug proven to help Covid-19 patients.
Where did the new cases of avascular necrosis emerge?
Three young patients under the age of 40 developed avascular necrosis two months after being treated for Covid in Hinduja Hospital, Mahim. “These patients developed pain in their femur bone (the highest part of the thigh bone) and, since they were doctors, they recognized the symptoms and rushed for treatment,’’ said Dr. Sanjay Agarwala, medical director of Hinduja Hospital, Mahim, was quoted as saying by the publication.
What is avascular necrosis?
The disease can affect anyone irrespective of Covid-19. It can be caused because of temporary or permanent loss of blood supply to the bone, according to Johns Hopkins Medicine. As a result of the cut in blood supply cut, the bone tissue dies and the bone collapses. If avascular necrosis occurs near a joint, the joint surface may collapse. This condition may happen in any bone.
Dr Agarwala has presented a research paper published on Avascular necrosis as a part of long Covid-19 in the prestigious medical journal ‘BMJ Case Studies’. According to him the “large-scale use of life-saving corticosteroids” in Covid-19 cases will result in a “resurgence of AVN cases”.
Patients may not show any symptoms in the early stages of the disease, but as the condition worsens there could be a pain in joints. Pain can be mild or severe which develops slowly. Pain associated with avascular necrosis of the hip might also be felt around the groin, thigh, or buttock. Besides your hip, it may also affect your shoulder, knee, hand, and foot.
According to the paper, post-COVID-19, there is a greater propensity to develop AVN, mainly if the patient has been on steroids. The literature suggests the mean dose of steroid in prednisone equivalents of 2000mg is required to cause AVN, but we feel that due to the COVID-19 virus, the sensitivity to develop AVN is higher and to a smaller cumulative dose of steroids
Can it be prevented?
Corticosteroids are life-saving in the management of COVID-19. Patients who had COVID-19 infection are more susceptible to avascular necrosis (AVN) development at (a) lower threshold dose of steroid and (b) earlier onset of presentation.
Hence, on early suspicion, on complaints of hip and thigh pain, diagnosis can be established by early MRI of the hips. Patients with early AVN (Ficat-Arlet stages I and II) can be successfully treated with bisphosphonate therapy, according to the study published.