Arthropathy Associated with Steroid Therapy

Risk factors for avascular bone necrosis in patients with systemic lupus erythematosus

“…Mok et al [13] reported that high-dose steroid administered within the first 4 months, the peak and the mean daily prednisolone dosage are independent risk factors for AVN. However, there are reports of patients with SLE complicated by AVN who had not been taking corticosteroid [14,15]. This leads to postulation that active SLE itself may be another predisposing factor for AVN.…”

Risk factors for avascular necrosis of bone in patients with systemic lupus erythematosus: Is there a role for antiphospholipid antibodies?

“…There have been many subsequent descriptions of AVN, but many reports that evaluated the proposed risk factors for its development in SLE failed to show consistent results supporting an association. Potential risk factors include corticosteroid use,1-5vasculitis,9 10 Raynaud's phenomenon,5 8and the presence of aPL. Our case-control study aimed at elucidating the role, if any, of the presence of aPL.…”

Avascular Necrosis of Bone: A Review1

“…However, isolated cases have been reported of patients with systemic lupus erythematosus who have never received steroids but who have developed avascular necrosis (Dubois & Crozen 1960, Siemsen et al 1962. Histological studies, with the exception of those of Velayos et al (1966), have shown evidence of vasculitis in the synovial tissue but not the intraosseous vessels. Gerle et al (1965) described 6 cases of avascular necrosis of the femoral head, the humeral head, femoral condyles and tibial plateau, but unfortunately described no histology.…”

“…It has been suggested that the blood vessels are occluded by fatty emboli in alcoholics who develop osteonecrosis. Velayos et al (1966) have noted the development of vasculitis in patients with systemic lupus erythematosus who develop osteonecrosis. There is no alteration in the mechanical properties of bone simply because the lacunae are devoid of osteocytes; bone may continue to function for a matter of months or sometimes years after infarction.…”