Avascular necrosis of the femoral head in scleroderma

Wilde, Alan H.; Rodnan, Gerald P.; Mankin, Henry J.

doi:10.1002/art.1780130414

Cited by 29 publications

(7 citation statements)

References 9 publications

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“…The dose intensity of methotrexate or l-asparaginase given with glucocorticoids may also be factors in the development of AVNB. 16,17 Individual susceptibility plays a role as well; some patients have experienced AVNB after receiving corticosteroids at a relatively low dose intensity. 18,19 The presenting symptoms of AVNB are usually progressive leg pain, articular pain, or both.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging detection of avascular necrosis of the bone in children receiving intensive prednisone therapy for acute lymphoblastic leukemia or non-Hodgkin lymphoma

Kennedy

et al. 2001

Leukemia

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The purpose of this study was to determine the frequency with which magnetic resonance (MR) imaging detects avascular necrosis of the bone (AVNB) in children with acute lymphoblastic leukemia (ALL) or advanced-stage non-Hodgkin lymphoma (NHL) who receive prednisone during remission induction, reinduction, and maintenance chemotherapy; to assess the clinical significance of these findings; and to identify factors predictive of AVNB. We prospectively obtained MR imaging of the hips and knees of 116 children who had completed at least 1 year of treatment for ALL or advanced-stage NHL on identical prednisone-containing regimens between December 1991 and October 1994. MR imaging findings of AVNB were compared with clinical outcomes, and the effect of therapeutic and patient factors on the frequency of AVNB was analyzed. The MR imaging findings of 17 of the 116 participating patients were consistent with AVNB. The most common clinical manifestation was joint pain (11 patients). Only one patient had progressive joint deterioration that necessitated surgical replacement. Only age 10 years or more at the time of the primary diagnosis was significantly associated with the development of AVNB (P = 0.004). MR imaging showed changes consistent with AVNB in approximately 15% of this patient population. However, most patients in this study who had MR imaging signs of AVNB did not experience progressive joint destruction, even with continued prednisone therapy. Therefore, the clinical usefulness of MR imaging as a screening tool for AVNB in this set of patients remains uncertain. Leukemia (2001) 15, 891-897.

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Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging detection of avascular necrosis of the bone in children receiving intensive prednisone therapy for acute lymphoblastic leukemia or non-Hodgkin lymphoma

Kennedy

et al. 2001

Leukemia

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“…Radiological changes in the joints of PSS subjects include periarticular osteoporosis, intra-articular calcification,9 erosions, loss of joint space,6 0-13 and rarely aseptic necrosis.4 15 Despite previously published studies, however, the pattern of joint involvement in this disease has not been clearly established. The wide variation in the reported prevalence of both clinical and radiological features, as well as their correlation with other disease parameters, requires clarification.…”

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confidence: 99%

The articular manifestations of progressive systemic sclerosis (scleroderma).

Baron¹,

Lee²,

Keystone³

1982

Annals of the Rheumatic Diseases

135

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SUMMARY The articular manifestations of progressive systemic sclerosis (PSS) were studied in 38 patients. Of these, 66 % experienced joint pain and 61 % had signs of joint inflammation. Limitation of joint movement was seen in 45 %. Radiological abnormalities included periarticular osteoporosis (42 %), joint space narrowing (34%), and erosions (40%). Erosive disease did not correlate with disease duration, presence of rheumatoid factor, antinuclear antibodies, distal tuft resorption, or the extent of the scleroderma skin changes. Calcinosis was seen more frequently in those patients with articular erosions (67 %). Erosive osteoarthritis of the distal interphalangeal joints (7 patients) was associated with impaired finger flexion. Joint involvement in PSS occurs frequently and may resemble rheumatoid arthritis in the early stages but is less destructive.

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“…They are usually limited to periarticular osteoporosis, mild joint space loss, and small discrete erosions at the joint margins [1,3,8,9], less common is aseptic necrosis [10].…”

Section: Discussionmentioning

confidence: 99%

Arthropathy in Patients with CREST Variant Scleroderma

Restrepo

Rondón

Matteson³

et al. 2006

CRR

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Background: Systemic sclerosis is a disease characterized by sclerosis of the skin, internal organs and vasculopathy. Articular manifestations are common, and include arthralgias, arthritis, and morning stiffness, which in some cases can be confused with rheumatoid arthritis (RA). Patients develop functional impairment and thickening of the skin including around the joints, with inflammation and fibrosis of tendon sheaths. However, articular inflammation is rare clinically, as is the development of articular erosions.Objective: To define the presence and characteristics of arthropathy in patients with scleroderma and distinguish it from RA.Methods: Case series of 106 Colombian patients with scleroderma evaluated between January 1998 and December 2004, of whom 5 had significant articular involvement and are the subject of this report.Results: All patients had the CREST variant of scleroderma. Their average age was 48.6 years (range 35-56). All had arthropathy affecting mainly the hands and feet. In the majority of cases the clinical picture resembled that of RA, with inflammation and subluxation of the metacarpophalangeal joints, and involvement of the feet with subluxation of the toes. Radiographs revealed joint space narrowing, subluxation, juxtaarticular osteopenia, carpal ankylosis and erosions. Rheumatoid factor was negative and antinuclear antibody (ANA) was positive with anticentromere antibodies in all patients. Conclusions:We conclude that there is a unique arthropathy of scleroderma which is due to inflammation and mechanical factors related to skin and periarticular involvement from the underlying disease. It is not due to coexisting RA. All of our cases had CREST variant scleroderma with erosive arthritis, negative rheumatoid factor, and positive ANA with centromere antibody. None fulfilled classification criteria for RA. This is a distinct subtype of scleroderma. Patients should be identified and treated promptly to avoid development of serious articular disease. The tendency to develop severe articular disease is likely immunogenetically linked.

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Avascular necrosis of the femoral head in scleroderma

Cited by 29 publications

References 9 publications

Magnetic resonance imaging detection of avascular necrosis of the bone in children receiving intensive prednisone therapy for acute lymphoblastic leukemia or non-Hodgkin lymphoma

Magnetic resonance imaging detection of avascular necrosis of the bone in children receiving intensive prednisone therapy for acute lymphoblastic leukemia or non-Hodgkin lymphoma

The articular manifestations of progressive systemic sclerosis (scleroderma).

Arthropathy in Patients with CREST Variant Scleroderma

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