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General recommendation for assessment and management on the risk of glucocorticoid-induced osteonecrosis in patients with COVID-19.
Li, Wenlong; Huang, Zeqing; Tan, Biao; Chen, Gang; Li, Xugui; Xiong, Kan; Zhu, Ruizheng; Li, Ruihan; Li, Shuwen; Ye, Hengli; Liang, Zhi; Dong, Xiaojun; Zhou, Shijing; Chen, Song; Xi, Haixiang; Cheng, Hao; Xu, Rongpeng; Tu, Shenghao; Chen, Zhe; Qi, Lihua; Song, Jiandong; Xiao, Ruoran; Liu, Huilan; Nan, Qian; Yu, Huiyong; Cui, Hongsheng; Shen, Yanguang; Wang, Chengxiang; Lin, Na; Zhang, Yanqiong; Chen, Weiheng.
  • Li W; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
  • Huang Z; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
  • Tan B; Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, PR China.
  • Chen G; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
  • Li X; Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, PR China.
  • Xiong K; Hubei College of Chinese Medicine, Jingzhou, 434020, PR China.
  • Zhu R; Hubei University of Chinese Medicine, Wuhan, 430065, PR China.
  • Li R; Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, 430079, PR China.
  • Li S; Wuhan Jiangxia District Hospital of Traditional Chinese Medicine, Wuhan, 430200, PR China.
  • Ye H; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
  • Liang Z; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
  • Dong X; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
  • Zhou S; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
  • Chen S; Guizhou University of Traditional Chinese Medicine, Guiyang, 550025, PR China.
  • Xi H; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
  • Cheng H; Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430014, PR China.
  • Xu R; Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, 430079, PR China.
  • Tu S; Hubei University of Chinese Medicine, Wuhan, 430065, PR China.
  • Chen Z; Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430014, PR China.
  • Qi L; Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, 430079, PR China.
  • Song J; Hubei College of Chinese Medicine, Jingzhou, 434020, PR China.
  • Xiao R; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China.
  • Liu H; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China.
  • Nan Q; Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, 430061, PR China.
  • Yu H; Hubei Integrated Traditional Chinese and Western Medicine Hospital, Wuhan, 430015, PR China.
  • Cui H; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
  • Shen Y; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
  • Wang C; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
  • Lin N; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
  • Zhang Y; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
  • Chen W; The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China.
J Orthop Translat ; 31: 1-9, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1472066
ABSTRACT
BACKGROUND/

OBJECTIVE:

Coronavirus disease 2019 (COVID-19) is a disaster in human medical history and glucocorticoids remain the most promising therapy. Osteonecrosis is a disease caused by reduced intraosseous blood flow to bones in the joints, which will rapidly induce joint destruction. Approximately one-third patients with severe acute respiratory syndrome (SARS) who received high cumulative doses and long treatment durations of glucocorticoids occurred osteonecrosis. Considering the similarity of SARS and COVID-19 on their pathogen, clinical characteristics, and therapeutic strategies, it is particularly desirable to investigate whether osteonecrosis will become a common sequela among convalescent COVID-19 patients.

METHODS:

This multi-strategy study was designed by integrating different research methods, such as meta-analysis, systematic review, and cross-sectional investigations to address above study objectives. At first, two meta-analyses were performed on the osteonecrosis incidence among SARS patients and the clinical data of glucocorticoid exposure among COVID-19 patients. Then, a systematic review of low-dosage glucocorticoid associated osteonecrosis and a cross-sectional investigation of glucocorticoid exposure of COVID-19 patients in Wuhan city of China were also conducted. Moreover, the pathogenesis, diagnosis, prevention, and treatment options for osteonecrosis patients with COVID-19 infection were further presented and discussed.

RESULTS:

Our meta-analysis showed that 32% of SARS patients had developed osteonecrosis after receiving glucocorticoid treatment with high dose, and our system review supported that low level glucocorticoid exposure might also lead to the occurrence of osteonecrosis. Similarly, 40% of COVID-19 patients had undergone glucocorticoid treatment according to our meta-analysis. The cross-sectional investigation in Wuhan city of China found that the average of cumulative glucocorticoid exposure level was 504 â€‹mg calculated by the dosage of methylprednisolone. Notably, a confirmed osteonecrosis case was identified from 1406 patients with COVID-19 during our cross-sectional investigation, implying that preventive management of osteonecrosis should be better started with regular clinical follow-up observation.

CONCLUSION:

Growing evidence of the glucocorticoid therapy for COVID-19 patients prompts us to establish risk-classification-based early screening and to introduce early prevention protocol of its associated osteonecrosis that will be of clinical significance in favor of improved prognosis of this disease. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE To establish risk-classification-based early screening and to introduce early prevention protocol of glucocorticoid-induced osteonecrosis will be of clinical significance in favor of improved prognosis of COVID-19.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Long Covid Language: English Journal: J Orthop Translat Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Long Covid Language: English Journal: J Orthop Translat Year: 2021 Document Type: Article