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Inicio Rehabilitación Edema óseo idiopático: evolución de 3 casos tratados con denosumab
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Vol. 53. Issue 2.
Pages 126-130 (April - June 2019)
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Vol. 53. Issue 2.
Pages 126-130 (April - June 2019)
CASO CLÍNICO
Edema óseo idiopático: evolución de 3 casos tratados con denosumab
Idiopathic bone marrow oedema: Outcome of 3 cases treated with denosumab
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M.B. Zaldibar Barinaga
Corresponding author
bzalbar@gmail.com

Autor para correspondencia.
, J.I. Reoyo Díez
Servicio de Rehabilitación, Hospital de Santa Marina, Bilbao (Vizcaya), España
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Resumen

El edema óseo idiopático se considera una entidad de fisiopatología no aclarada y origen multifactorial que afecta a personas de mediana edad; se caracteriza por dolor e impotencia funcional en extremidades inferiores asociados a hallazgos característicos en resonancia magnética: imágenes hipointensas en T1 e hiperintensas en T2 en las articulaciones afectadas. Presentamos 3 casos clínicos de varones (edad: 45-64), 2 en rodillas y uno en cadera. Inicio con dolor intenso (EVA ≥ 5), sin desencadenante claro e impotencia funcional con imágenes características en resonancia magnética. Tratamiento: vitamina D (20.000 UI/semana vía oral) y dosis única subcutánea de denosumab (60mg) (indicación fuera de ficha técnica), descarga de articulación afectada y ejercicios autoasistidos de mantenimiento de recorrido articular. Evolución favorable con resolución clínica y del edema óseo, sin complicaciones reseñables. El denosumab se muestra como una opción de tratamiento para la resolución clínico-radiológica del edema óseo idiopático y parece acortar la evolución natural del proceso.

Palabras clave:
Edema óseo idiopático
Tratamiento
Denosumab
Rehabilitación
Abstract

Idiopathic bone marrow oedema is considered an unclarified pathophysiological entity of multifactorial origin affecting middle-aged persons; it is characterised by pain and functional limitation of the lower extremities. Characteristic findings on magnetic resonance imaging are hypointense T1 and hyperintense T2 images in the affected joints. We present 3clinical cases of BMO in men (age: 45-64 years), involving 2knees and one hip. Onset occurred with intense pain (VAS ≥ 5), with no clear cause and functional limitation with characteristic images on magnetic resonance imaging. Treatment consisted of vitamin D 20,000 IU/week orally and a single subcutaneous dose of denosumab 60mg (off label use). The patients avoided weight bearing on affected joints and conducted self-assisted exercises to maintain range of movement. Outcome was favourable with clinical and bone oedema resolution, with no notable complications. This report demonstrates that denosumab is a treatment option for the clinical/radiological resolution of bone marrow oedema and seems to shorten the clinical course of the process.

Keywords:
Bone marrow oedema
Treatment
Denosumab
Rehabilitation

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