Osteonecrosis

Chang, Christopher; Greenspan, Adam; Beltran, Javier; Gershwin, M. Eric

doi:10.1016/b978-0-323-31696-5.00103-0

Cited by 9 publications

(12 citation statements)

References 189 publications

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“…Other sites namely knees, shoulders, wrists, ankles as well as multifocal areas may also be involved in SLE associated osteonecrosis. [ 2 ] In our study, femoral head was the most common site affected, with significant proportion of them, being bilateral (61.9%). Other sites involved in our patients were distal femur and proximal humerus.…”

Section: Discussionmentioning

confidence: 58%

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Clinical profile of osteonecrosis in systemic lupus erythematosus – Experience from a tertiary care centre in South India

Chinnadurai

Chilukuri

Mahendran

et al. 2020

J Family Med Prim Care

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Introduction: Osteonecrosis or Avascular necrosis of bone (AVN) is a well recognized complication of systemic lupus erythematosus (SLE) leading to significant morbidity. Methods: We did a cross sectional descriptive study in cohort of SLE patients, on regular follow-up at our Rheumatology OPD over a period of 5 years from 2012 to 2017. Results: Of the total 415 SLE, 5.1% ( n = 21) patients were diagnosed to have osteonecrosis. The mean age was 32.8 ± 7.6 years. Male: female were 1:4.2. Mean time interval between the onset of SLE and diagnosis of osteonecrosis was 4.1 ± 2.7 years. Pain (100%) was the most common presenting symptom followed by limping gait (42.8%). Most common site affected by osteonecrosis was femoral head (80.9%) ( n = 17). 14.3% ( n = 3) had multifocal involvement. The most common systemic involvement was musculoskeletal system (80.9%). In total 28.5% had secondary antiphospholipid syndrome. Mean SLEDAI-2K at the time of diagnosis of osteonecrosis was 5.3 ± 2.9. Hypertension 19%, hypothyroidism 9.5%, osteoporosis 24%, and chronic HCV infection 4.7% were the associated comorbidities. The most common stage by imaging at diagnosis was stage IV (38%), followed by 24% stage V, 19% stage III and 9.5% stage II and 9.5% stage VI. Medical management include bisphosphonates (100%), statins (90.4%) and anticoagulant therapy (28.5%), while 9.5% received core decompression surgery and 14.3% underwent total hip replacement. The mean daily dose of prednisolone at diagnosis of osteonecrosis was 8.5mg (range 5–20mg). Conclusion: This study described the prevalence and epidemiology of osteonecrosis in our cohort of SLE patients.

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Section: Discussionmentioning

confidence: 58%

“…Other risk factors for osteonecrosis include chronic alcohol consumption, cigarette smoking, radiation exposure, pregnancy, and corticosteroid therapy. [ 1 2 ]…”

Section: Introductionmentioning

confidence: 99%

Clinical profile of osteonecrosis in systemic lupus erythematosus – Experience from a tertiary care centre in South India

Chinnadurai

Chilukuri

Mahendran

et al. 2020

J Family Med Prim Care

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“…This means that genetic factors can be the cause of disease emergence and are closely related to other pathogenesis factors [ 5 – 8 ]. The risk of FHOM increases in the presence of these genetic predisposing factors [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Integrative analyses of genes related to femoral head osteonecrosis: an umbrella review of systematic reviews and meta-analyses of observational studies

2022

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Background Femoral head osteonecrosis (FHON) is a worldwide challenging clinical topic. Steroid use is one of the main etiologies of FHON. There are several genetic variants associated with FHON. Therefore, the purpose of this umbrella review was to provide a comprehensive summary of a meta-analysis and systematic review of genetic variations associated with nonsteroidal and steroid-induced FHON. Methods The eligible studies were selected from the PubMed and MEDLINE databases for the collection of diverse systematic meta-analyses and reviews. The genetic main effect score was assigned using the Human Genome Epidemiology Network’s Venice criteria to assess the cumulative evidence on the effects of a single nucleotide polymorphism (SNP) on FHON. Results Eight articles reported the meta-analysis of candidate SNP-based studies covering eight genes and 13 genetic variants. In the nonsteroid-induced FHON genetic variants including rs2012390 and rs11225394 in MMP8, rs1800629 and rs361525 in tumor necrosis factor (TNF)-α, VNTR in intron 4, rs1799983 and rs2070744 in endothelial nitric oxide synthase (eNOS), rs2010963 in vascular endothelial growth factor (VEGF), and rs6025 in factor V showed significance in each reference. The steroid-induced FHON genetic variants including rs693 and rs1042031 in apolipoprotein (Apo)B, rs1045642 in ABCB1, and rs1799889 in PAI-1 showed significance in each reference. Conclusion Based on the systematic review conducted in this study, we organized the genomes associated with FHON and looked at each contribution. Our results could give an integrative approach for understanding the mechanism of FHON etiology. It is expected that these results could contribute to the strategy of prediagnosis, evaluating the individual risk of nonsteroid-induced and steroid-induced FHON. Level of Evidence: Level I.

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“…It is estimated that between 10 000 and 20 000 patients are diagnosed each year in the United States alone. 1 Avascular necrosis can range in severity and clinical presentation, from mild pain to complete disability with significant loss of function. Diagnosis is most commonly made by radiographic imaging.…”

Section: Introductionmentioning

confidence: 99%

“…2 Avascular necrosis has been linked to multiple conditions and factors, including chemotherapy, but most commonly is association with corticosteroid use. 1 Avascular necrosis is more common among adults, but has been shown to affect pediatric patients as well. Acute lymphoblastic leukemia (ALL) is a malignancy of hematopoietic stem cells that originates from B- and T-cell lineage lymphoid precursors and is driven by a spectrum of genetic aberrations.…”

Section: Introductionmentioning

confidence: 99%

Selective Ulnar Nerve Decompression, Capsular Branch Denervation, and Arthroscopic Debridement as a Unique Technique to Improve Quality of Life for Avascular Necrosis of the Distal Humerus and Radius in a Young Patient With ALL

Reddy

Seaman

Jefferson

et al. 2022

Hand (New York, N,Y.)

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Avascular necrosis (AVN), one of the most common therapy-related and debilitating side effects of antileukemic treatment, can adversely affect a patient’s long-term quality of life. Our case study presents a young woman with bilateral elbow AVN and hip AVN after acute lymphoblastic leukemia treatment, with a unique treatment strategy for her elbow pain. The treatment strategy included elbow joint denervation with arthroscopic debridement and distal humerus core decompression. The goal of this procedure was to improve symptomatic pain while retaining bone stock in the distal humerus hopefully allowing better function of the patient’s elbow. This treatment may not only improve the quality of life in a young patient but also delay the need for future surgery. Our patient had improved pain relief in her elbow postsurgery. This procedure may be used for pain control and may have beneficial future implications in this limited population.

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Osteonecrosis

Cited by 9 publications

References 189 publications

Clinical profile of osteonecrosis in systemic lupus erythematosus – Experience from a tertiary care centre in South India

Clinical profile of osteonecrosis in systemic lupus erythematosus – Experience from a tertiary care centre in South India

Integrative analyses of genes related to femoral head osteonecrosis: an umbrella review of systematic reviews and meta-analyses of observational studies

Selective Ulnar Nerve Decompression, Capsular Branch Denervation, and Arthroscopic Debridement as a Unique Technique to Improve Quality of Life for Avascular Necrosis of the Distal Humerus and Radius in a Young Patient With ALL

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