Skip to comments.Bone Disease Worry for Former SARS Patients
Posted on 10/10/2003 4:59:51 AM PDT by FairOpinion
HONG KONG (Reuters) - Dozens of former SARS patients in Hong Kong are suffering from bone degeneration, known as avascular necrosis, sources said Friday, throwing the spotlight back on the controversial cocktail of drugs used to treat many patients during the epidemic.
"A substantial number of cases have already been proven. We are now trying to ascertain the severity," said Leung Ping-chung, an orthopedics specialist at the Prince of Wales Hospital, where the first wave of SARS infections in Hong Kong were treated.
Almost all SARS patients in Hong Kong were treated with the anti-viral drug ribavirin and steroids earlier this year, but many health experts said at the time the efficacy of the combination was unproven and could lead to serious side-effects.
At least 10 former SARS patients from every major public hospital that tended to SARS victims in Hong Kong have been found suffering from the bone disease, Leung said. At least eight public hospitals handled SARS patients.
Avascular necrosis has also been observed in some former SARS patients in mainland China, Leung told Reuters.
"It must be a general problem (in places which treated their patients using steroids)," Leung said, adding that steroids were used in many of the 30 countries affected by SARS.
In Singapore, where more than 200 people were infected with SARS and 33 of them later died, a hospital spokeswoman said no one was known to be suffering from bone degeneration.
"Now that we see this information from Hong Kong, doctors are on heightened awareness on this matter," said the spokeswoman at Tan Tock Seng Hospital, Singapore's SARS-designated hospital.
Hong Kong's hospital chief recently said that SARS patients would be treated with an HIV drug, Kaletra, and ribavirin in future. Such a combination would need lower dosages of steroids.
LINK WELL DOCUMENTED
The link between avascular necrosis and heavy use of steroids is well documented. It occurs when blood supply to the bone is impaired, causing the bone to die and finally collapse.
Long bones like the femur -- the bone extending from the knee to the hip joint -- are particularly susceptible. The disease can be disabling, with the sufferer needing joint replacement.
Leung Ka-lau, former head of the Public Doctors' Association in Hong Kong, said the condition could surface later in some people.
Apart from impairing blood circulation and causing avascular necrosis, heavy use of steroids can also damage the lungs.
A government spokeswoman said the Hospital Authority in Hong Kong was recalling all recovered SARS patients for urgent checks.
"We are recalling all recovered patients to give them checks, we are now studying if it has to do with the treatment," the spokeswoman said.
A 51-year-old former bus driver is one of the former SARS victims suffering avascular necrosis. The father of three was put on steroids for three months and now has 50 percent bone degeneration in his right leg and 10 percent in his left leg.
"He feels great pain just walking. He is going for a major operation on his right leg Monday," said a social worker.
More than 1,750 people in Hong Kong fell victim to the SARS virus between February and June this year after it first surfaced in south China in November. Nearly 300 of them died.
Experts have warned that the deadly disease, which infected over 8,000 people worldwide and killed more than 700 of them, may return during the winter months.
Could it be the SARS or the treatment? I think I read that too much cortisone can cause bone degenaration.
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- John Adams -
This seems like a prudent thing to do even if the bone loss wasn't an issue.
I have always been suspicious of the 'drug cocktail' doctors like to try out for any sort of affliction. Anyone have an idea of what this particular mixture would do to one?
No study has been done to even evaluate this idea.
The avascular necrosis could be due to the inflammatory response to infection in the disease. That's what seems to cause the lung damage.
Medical experts met in Hong Kong for a two-day symposium on SARS. Hong Kong says most SARS victims have shown good responses to a combination of the antiviral medicine ribavirin and steroids. But global health officials have doubts and doctors from Singapore and Canada said late Friday they've not seen good results from those drugs.
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