La “poussée” dolorosa acuta dell’artrosi di ginocchio con concomitante edema midollare: efficacia del trattamento con bisfosfonati parenterali

Abstract

Knee osteoarthritis is a frequent clinical condition in the elderly population, characterized by chronic low or mild pain with the occasional occurrence of severe pain. Acute pain in knee osteoarthritis is often related to the presence of bone marrow edema on magnetic resonance (MR). Bisphosphonates are reported to be effective in the treatment of pain in clinical conditions characterized by bone marrow edema on MR imaging, such as transient osteoporosis of the hip, reflex sympathetic dystrophic syndrome and sacroileitis in spondyloarthritis. We report on the case of a 75-year-old woman affected by knee osteoarthritis with acute pain, refractory to conventional therapies with NSAIDs and intra-articular hyaluronic acid and corticosteroids. MR imaging showed an extensive signal alteration of the medial compartment of the right knee, hyperintense on T1-weighted and hypointense on T2-weighted and STIR sequences, suggestive for the presence of bone marrow edema. She was treated with intravenous pamidronate at the dosage of 60 mg, administered four times, once every third day. She reported a significant pain reduction in two weeks and complete pain relief in two months. MR performed two months later showed bone marrow edema disappearance. Our experience suggests that a short course of pamidronate could be effective in the treatment of acute pain related to symptomatic knee osteoarthritis with bone marrow edema, and it could be considered as an innovative therapeutic approach to pain refractory to standard therapies.