Parenteral iloprost in the symptomatic treatment of hip osteoarthritis

Abstract

Background: Iloprost is a prostacyclin analogue that has been used in the treatment of symptomatic bone marrow edema of different aetiology. Objective: To present a case of bilateral hip osteoarthritis treated with intravenous iloprost. Case: A 32-year old Filipino female presented with pain in the lower back and bilateral hip of two years duration, precipitated by weight-bearing activities such as prolonged standing and walking long-distances, and temporarily relieved by rest. She had no known co-morbid conditions, denied intake of any herbal or over-the-counter medications, but had a history of practicing mixed-martial arts for eight years. Complete blood count, blood chemistries and inflammatory markers were all normal. Radiographs of the hips showed sclerosis on the superior portion of the left acetabulum consistent with osteodegenerative changes. Magnetic resonance imaging of the hips revealed subtle heterogenous marrow signals within both acetabulum and femoral heads with minimal effusion. Bone marrow edema, probably of osteoarthritic etiology was diagnosed. Beginning avascular necrosis was also considered. The patient was given Iloprost 20 ug daily intravenous infusions for six doses. No untoward event was noted. Hip pain decreased by 50% after the second dose (from VAS 7/10 to VAS 3/10), and completely resolved after the fifth dose. The patient was subsequently advised off-loading for 3 to 4 weeks and was prescribed physical therapy for gait training. Conclusion: Iloprost is a prostacyclin analogue that may be used in the symptomatic treatment of bone marrow edema of different causes, including osteoarthritis.