What is the diagnosis and treatment for Asymptomatic Osteonecrosis (Aseptic Necrosis)?

From the Guidelines

Asenapine is not relevant to the provided evidence, and the question seems to be a typo, potentially referring to a different condition or medication, but based on the provided evidence, it does not relate to any known condition or treatment. However, considering the context of the provided evidence which discusses chronic non-bacterial osteitis (CNO) and its treatment, it seems there might be confusion in the question's intent. Given the information provided in the study 1, it focuses on the diagnosis and treatment of CNO in adults, suggesting the use of non-steroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase 2-inhibitors as first-line treatment, followed by intravenous bisphosphonates or tumor necrosis factor-α inhibitors as second-line options. The key points from the study 1 include:

• The recommendation for initial imaging evaluation of adults with suspected CNO to be MRI or CT combined with nuclear imaging.
• Whole-body imaging at initial evaluation for diagnostic and prognostic purposes.
• The suggested first-line and second-line treatments for active CNO. Since the question does not directly relate to the provided evidence, and without further context or clarification on "Asenomiosis," it's challenging to provide a specific recommendation based on the morbidity, mortality, and quality of life outcomes. However, if we consider the importance of accurate diagnosis and treatment in conditions like CNO, as discussed in the study 1, it's crucial to approach any condition with a thorough evaluation and evidence-based treatment options to improve patient outcomes. In real-life clinical practice, when faced with an unclear or potentially misdiagnosed condition, it is essential to prioritize a comprehensive diagnostic workup and consider consulting relevant guidelines or expert opinions to ensure the best possible patient care.

From the Research

Definition and Diagnosis of Adenomyosis

• Adenomyosis is a clinical condition where endometrial glands are found in the myometrium of the uterus 2
• It is distinct from endometriosis, but the two conditions often occur simultaneously 2
• Diagnosis of adenomyosis begins with clinical suspicion and is confirmed with transvaginal ultrasonography and pelvic magnetic resonance imaging 2, 3

Symptoms of Adenomyosis

• Heavy menstrual bleeding is the most common symptom of adenomyosis 2
• Other symptoms include pelvic pain and infertility 2, 3
• One in three patients with adenomyosis is asymptomatic 2

Treatment Options for Adenomyosis

• Treatment of adenomyosis typically starts with hormonal menstrual suppression 2
• Levonorgestrel-releasing intrauterine systems have shown some effectiveness in treating adenomyosis 2, 4, 5
• Other treatment options include non-steroidal anti-inflammatory drugs, steroid hormones, gonadotropin releasing hormone agonists, and mifepristone 4, 5
• Surgical options, such as hysterectomy, may be considered if symptoms are not controlled with medical therapy 2, 6

Management of Adenomyosis

• Drug therapy plays an important role in alleviating the symptoms related to adenomyosis and improving the curative effect of surgery 5
• Drug selection should be based on patient's age, symptoms, uterine size, fertility requirements, and economical conditions 5
• There is no specific drug for adenomyosis, and symptoms are easy to recur after drug withdrawal, so the long-term drug use needs further study 5