Avascular necrosis is known to occur as a side effect of strong doses of corticosteroids, said Dr Julie Hall, leader of the World Health Organization SARS Response Team in China in an exclusive interview with China Daily in Beijing on Tuesday.

And strong doses of corticosteroids were widely used by doctors in the first half of this year in China to save the lives of many SARS patients.

Some studies suggest that corticosteroid-related avascular necrosis is more severe and more likely to affect both hips (when occurring in the hip) than avascular necrosis resulting from other causes, Dr Hall noted.

Recent reports reveal that many people who recovered from SARS several months ago are now suffering from avascular necrosis, especially in the hips, on the Chinese mainland, which has seen a total of 5,327 SARS patients, including 4,959 who recovered.

The incidence of corticosteroid-related avascular necrosis in the hips of medical staff of the main hospitals in Beijing who have recovered from SARS, is from about 33 percent to 50 percent, Xu Lin, director of the orthopedics center of Beijing Dongzhimen Hospital, was quoted as saying by Beijing News.

Xu is head of a group of experts dealing with the treatment of avascular necrosis of SARS patients using traditional Chinese medicine and western medicine.

However, such a rate is only an estimate by doctors based on their clinic experience in some hospitals, and has not been proven by health authorities.

The Ministry of Health has set up a group of experts to investigate the sequelae situation of SARS patients, especially avascular necrosis of the hips, an official from the ministry who refused to be identified, told China Daily yesterday.

The sequelae situation of SARS patients, including avascular necrosis of the hips needs further investigation before further measures can be taken by health authorities to tackle the problem, the unnamed official noted.

Although doctors knew of the side effects of using corticosteroids to treat SARS patients, they had no other choice at that time if they were going to save people's lives, said Dr Hall.

Corticosteroids can restrict the large vein that supplies blood to the ball joint at the upper end of the femur. The shortage of blood causes the bone in that area to die, she added.

During the SARS epidemic, a research project themed "the medical treatment and recovery of SARS patients" was launched by the Ministry of Science and Technology with an investment of nearly 10 million yuan (US$1.2 million).

(China Daily November 26, 2003)