From the Guidelines
Osteitis pubis should be treated with a conservative approach, starting with rest and activity modification, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for 1-2 weeks to manage pain and inflammation, as recommended by expert consensus guidelines 1. The treatment goals for osteitis pubis, also known as chronic non-bacterial osteitis (CNO), include relieving symptoms, maintaining or regaining functional capacity, reducing inflammation, and preventing structural musculoskeletal damage, as outlined in the expert consensus recommendations 1. Some key points to consider in the treatment of osteitis pubis include:
- Assessing disease activity based on clinical symptoms and radiological measures, such as bone marrow oedema or increased tracer uptake in the clinically and/or radiologically suspect lesions 1
- Using NSAIDs/COXIBs as first-line treatment, with the option to add or advance to second-line treatment, such as intravenous bisphosphonates or tumour necrosis factor-α inhibitors, depending on patient characteristics and response to treatment 1
- Evaluating treatment response at regular intervals, such as 2-4 weeks and 12 weeks, and adjusting treatment accordingly 1
- Considering physical therapy, patient education, and lifestyle recommendations as part of a comprehensive treatment plan 1
- Being aware of potential complications and adverse effects of treatment, such as neurovascular complications and vertebral fractures, and monitoring for these accordingly 1
From the Research
Definition and Symptoms of Osteitis Pubis
- Osteitis pubis is a non-infectious inflammation of the pubic symphysis, causing lower abdominal and pelvic pain 2, 3, 4, 5.
- The primary symptom is pain, typically associated with difficulty in ambulation and a characteristic "waddling gait" 3.
- Other symptoms may include a low-grade fever, elevated sedimentation rate, and mild leukocytosis 3.
Causes and Risk Factors
- Osteitis pubis can be caused by various factors, including athletic activities, pelvic surgery, and parturition 3, 4, 5.
- The condition is more common in men than women, according to some reports 5.
- Periosteal trauma is thought to be an important initiating event in the development of osteitis pubis 3.
Diagnosis and Treatment
- Diagnosis is made based on physical, radiographic, and laboratory examinations, including radiographs, bone scans, and magnetic resonance imaging 3, 4, 5.
- Treatment options include conservative measures such as rest, physical therapy, and oral nonsteroidal or glucocorticoid anti-inflammatory medications 2, 3, 4, 5.
- Surgical treatment, including arthrodesis, may be necessary in severe cases or for patients who do not respond to conservative therapy 2, 4, 5, 6.
- Corticosteroid injections, wedge resection of the symphysis, curettage, and arthrodesis have also been used with variable success 5, 6.