Avascular necrosis of bone in systemic lupus erythematosus: possible role of haemostatic abnormalities.

Abstract

SUMMARYThe pathogenesis of avascular necrosis of bone (ANB) was investigated in 111 patients with systemic lupus erythematosus (SLE) (24 with ANB, 87 without ANB); patients' ages, corticosteroid treatment, clinical and laboratory features associated with SLE, and haemostatic profiles were all taken into account. The mean ages of patients with and without ANB at the time of diagnosis of SLE was 24-1 and 31*2 years respectively. The mean maximal daily dose of prednisolone in the group with ANB was 50*8 mg, which was significantly higher than the dose (41*8 mg) in the group without ANB. Disease features of SLE, such as Raynaud's phenomenon, hyperlipidaemia, nephrotic syndrome, hypertension, and disease activity, were not found to be related to ANB. The percentage of patients who had lupus anticoagulant as well as a shorter activated partial thromboplastin time was greater in those with ANB than in those without. Multiple factors may be involved in the pathogenesis of ANB in SLE, and it is suggested that haemostatic abnormalities, which could be influenced by corticosteroids and young ages, play some part in the development of ANB.Since 1960 when Dubois and Cozen suggested an association of avascular necrosis of bone (ANB) with systemic lupus erythematosus (SLE),1 ANB has continued to be one of the major problems during the course of SLE. Corticosteroids, which are used for most patients with SLE, have been implicated as one cause of ANB, 6 but multiple factors, such as vasculitis,7 8 fat emboli,9 10 Raynaud's phenomenon,6 11 and young ages,12 13 must contribute to its development. As ANB may result from interference with the blood supply,7 haemostatic abnormalities and factors which induce them could also contribute to its occurrence.In this study we attempted to determine the predisposing factors for ANB in SLE, considering particularly patients' ages, corticosteroid treatment, and haemostatic state.

The use of joint-specific and whole-body MRI in osteonecrosis: a study in patients with juvenile systemic lupus erythematosus

“…Houssiau et al [24], in their report of a study of ON in SLE patients, stated that the prevalence of ON in SLE did not correlate with aCL; others have found a positive relationship with the presence of lupus anticoagulant [25,26], or between ON and IgG aCL in caucasian patients [23]. In all of these studies, the patients had received GC, which is the major predisposing factor for ON.…”

Outcomes and prognosis in systemic lupus erythematosus

“…Однако характер этой зависимости оцени вается по-разному. Так, одним авторам удалось выявить связь АВН с суммарной дозой ГК, другим -с суточной, третьим -со средней максимальной дозой [47,49,62,63]. Нет единого мнения по поводу влияния пульс-терапии ме-тилпреднизолоном на возникновение этого осложнения.…”

“…Нет единого мнения по поводу влияния пульс-терапии ме-тилпреднизолоном на возникновение этого осложнения. Ряд авторов сообщают, что данный вид интенсивной тера пии предшествовал развитию АВН [39,47]. Однако в других исследованиях не удалось установить взаимосвязи между пульс-терапией ГК и развитием АВН [40,43,49,63].…”

Avascular necrosis of bone with hemiparesis: a rare presentation of primary antiphospholipid antibody syndrome

“…6 A possible link between AVN and aPLs has been postulated, but the relationship is still unproven; the lack of other risk factors points to a suspected etiological role of antiphospholipid antibodies in AVN syndrome. 7,8 Strokes and transient ischemic attack (TIA) are considered the second most common clinical manifestations of APS after venous thrombosis. 9 The cerebral ischemia, which is mainly focal, can be transient or permanent.…”