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 Rh eum atology Unit becaus e of a recent bilateral sh oulder and hip pain. He had been treated from 1990 to 2000 with Cyclosporin A and Sulfasalazyn becaus e of an ulcerative colitis which was completely in remiss ion from 2000 . Glucocorticoids at th e mean daily dose of 50 mg were administ ered only in th e first period (1990-92) X- plain raysys shshowed a sussussuspiciousus mumultifocal oststeonecrosis of bothth femoral and hum eral heads. Magnetic Resonance confirmed th e diagnosis (st age III and IV following Ficat and Arlet's criteria). The patient was treated with a cycle of hyhyperbaric oxyg en th erapy, with two cycles of intravenous clodronate and with a 2-month cycle of teriparatide. The treatmtment was able to save a sufsufsufficient fufunction for bothth shshoulders, while for both hips arth roplasty th e su rgery was required. The risks of ost eonecrosis linked to inflammatory bowel diseases or to its th erapy are discussed.