Avascular necrosis in SLE. An apparent predilection for young patients.

Smith, Fannie E.; Sweet, Donald E.; Brunner, C; Davis, Jane S.

doi:10.1136/ard.35.3.227

Cited by 76 publications

(35 citation statements)

References 9 publications

(7 reference statements)

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“…We found that age at onset of SLE and age at diagnosis of SLE were lower in patients with AVN than in those without, which is in agreement with other reports [5,11]. However, this relationship has not been shown in another study [12].…”

Section: Discussionsupporting

confidence: 93%

“…The prevalence rate of AVN in SLE varies widely and ranges from 2 to 30% [1][2][3][4][5][6][7][8][9]. In a cohort of 407 patients with SLE, Petri [2] reported a 14.5% prevalence of AVN.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of AVN in patients with SLE has been reported to be about 2-30%, which is higher than that of general AVN. Although many risk factors such as corticosteroid therapy, vasculitis, coagulopathy, antiphospholipid antibody, Raynaud's phenomenon and fat emboli have been reported for AVN in patients with SLE, a proven association factor has not been found yet [1][2][3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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

Sayarlıoğlu

İnanç

et al. 2010

Rheumatol Int

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The objective was to investigate the predictive factors for avascular necrosis (AVN) of bone in patients with systemic lupus erythematosus (SLE). The records of 868 patients with SLE from four centers were reviewed retrospectively. Forty-nine patients with AVN were identified. A total of 154 patients with SLE who did not have clinically apparent AVN during the follow-up were evaluated as a control group. The demographic, clinical, laboratory and management characteristics of these two groups of patients were recorded according to predefined protocol and compared. The prevalence of AVN was detected 6% in our SLE population. The highest dose corticosteroid administered within 4 months and total cumulative prednisolone dose were significantly higher in the SLE patients with AVN. The use of cytotoxic agent significantly higher proportion of patients with AVN. AVN tends to develop more frequently in male gender and younger patients. Oral ulcer, pleuritis, Raynaud's phenomenon, cutaneous vasculitis, lymphadenopathy, autoimmune thyroiditis, peripheral neuropathy and Sjögren's syndrome were higher incidence in SLE patients with AVN. The bilateral femoral heads were the commonest site of involvement of AVN in our patients with SLE.

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Section: Discussionsupporting

confidence: 93%

“…The prevalence rate of AVN in SLE varies widely and ranges from 2 to 30% [1][2][3][4][5][6][7][8][9]. In a cohort of 407 patients with SLE, Petri [2] reported a 14.5% prevalence of AVN.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Sayarlıoğlu

İnanç

et al. 2010

Rheumatol Int

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“…(1,3,4,6,7,(26)(27)(28)(29) (15,(32)(33)(34)(35)(36)(37) (Fig. 1) as previously reported (38), probably because the lateral view of DEXA more accurately estimates trabecular bone mass compared with the AP view (39).…”

Section: T a B L E 2 Co Mp A R I S O N O F T H E Cl I N I C A L F Esupporting

confidence: 74%

Notable Difference between the Development of Vertebral Fracture and Osteonecrosis of the Femoral Head in Patients Treated with High-dose Glucocorticoids for Systemic Rheumatic Diseases

et al. 2009

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“…These investigations underestimated the children, AVN associated with SLE has been identified at several bony sites, most commonly affecting the proximal or distal femur and humerus, with a prevalence of 5.4-8.4% [9,10]. Carpal AVN with SLE has been reported in young adults affecting the lunate, but there is no published literature regarding children.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

J Rheum Dis Treat

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Avascular necrosis is a known complication of systemic lupus erythematosus. We report an unusual case of avascular necrosis affecting both the lunate and triquetrum in a child with this condition. Vasculitis, synovitis and IgM anticardiolipin antibodies were probable predisposing factors. The use of arthroscopic synovial debridement improves symptoms even in the presence of carpal chondromalacia and potentially delays the need for salvage surgery. *Corresponding author: Darren Roberts, Department of Hand, Plastic and Reconstructive Surgery, Birmingham Children's Hospital, UK, E-mail: robertsdc@doctors.org.uk CASe RepORT Check for updatesWe present, to our knowledge, the first case of synchronous lunate and triquetral AVN in a child with SLE. The aetiology and management of carpal AVN in childhood SLE are also discussed based on the available literature. Case ReportA 14-year-old girl, diagnosed with SLE five years previously, presented with a two-year history of non-traumatic pain and stiffness of her right dominant wrist. She was able to write and self-care, however she was unable to partake in hand-held ball and racquet sports at school.Although she previously had received a short course of prednisolone for associated lupus nephritis, she was medication free for over two years prior to the onset of wrist pain. Supplementary immunosuppressive treatments, including hydroxychloroquine and mycophenolate, had successfully abated any acute flare-ups. She had not reported any swelling around her wrist or any other joint inflammation for several years. Examination revealed flexion-extension of 75°/35°, radio-ulnar deviation of 10°/25°, and full prono-supination. There was tenderness over the triangular fibrocartilage complex (TFCC) and radio-carpal joint dorsally, painful lunotriquetral translation test, but no effusion or palpable synovitis.Plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) findings revealed multifocal intra-osseous cysts and lunotriquetral AVN (Figure 1, Figure 2 and Figure 3).

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Avascular necrosis in SLE. An apparent predilection for young patients.

Cited by 76 publications

References 9 publications

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

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

Notable Difference between the Development of Vertebral Fracture and Osteonecrosis of the Femoral Head in Patients Treated with High-dose Glucocorticoids for Systemic Rheumatic Diseases

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