July 15, 2021 10:50:08 am
Steroids have been widely used for treating Covid-19. As a result of long-term use of corticosteroids (especially at high doses), many patients have been experiencing fungal infections like mucormycosis, and now avascular necrosis (AVN) — a health complication that causes the death of bone tissues, doctors highlight.
Why are steroids used?
When one gets infected with Covid, there is an initial phase where the virus replicates and grows in the body. This is followed by inflammation in the second week, and steroids are administered to lower this inflammation. However, excessive and prolonged use of steroids can suppress natural immunity when used for patients with low oxygen levels. Many patients using steroids hence experience problems like Avascular Necrosis (AVN).
“Earlier, mucormycosis or black fungus was seen in post-covid patients. Now, AVN is also another worrisome problem seen during the first and second waves of Covid owing to the use of steroids. Avascular necrosis, also called osteonecrosis, can be termed as the death of bone tissue owing to the lack of blood supply. It can lead to tiny breaks in the bone which leads the bone to collapse. A broken bone or dislocated joint can interrupt the blood flow to a section of bone,” said Dr Anand Jadhav, orthopedic specialist, Apollo Spectra Pune, who has been seeing around 10-15 patients with AVN every month for treatment.
How does the condition manifest?
In AVN patients, there is increased pressure in the bones inside the sphincter due to its rigid structure.
What all does AVN affect?
Dr Keerthi Prakash Kotla, consultant pathologist, Apollo Diagnostics, said that pain related to AVN can be felt around the groin, thigh, or buttock. “Besides your hip, it may also affect your shoulder, knee, hand, and foot. Hence, on complaints of hip and thigh pain, diagnosis can be done by early X-ray, CT scan, MRI, and bone scan of the hips,” she mentioned.
Core decompression surgery is performed if the AVN is in the first and second stages. This reduces the pressure inside the ball. Joint replacement surgery is the only option to reduce permanent pain in the third and fourth stages of AVN disease. “However, surgery is not required if AVN is diagnosed early. Therefore, Covid patients on steroids having groin or thigh pain are advised to take an MRI or X-ray to check if they have AVN of the hip,” mentioned Dr Jadhav.
What can be done to reduce the risk of AVN?
Limit your alcohol intake, monitor cholesterol levels, do not misuse steroids without a doctor’s knowledge, and avoid smoking to manage AVN, noted Dr Kotla.