Very early development of steroid-associated osteonecrosis of femoral head in systemic lupus erythematosus: prospective study by MRI

Nagasawa, Kohei; Tada, Yutaka; Koarada, Syuichi; Horiuchi, Takahiko; Tsukamoto, Hiroshi; Murai, Koichi; Ueda, Akira; Yoshizawa, S.; Ohta, Akio

doi:10.1191/0961203305lu2103oa

Cited by 106 publications

(94 citation statements)

References 23 publications

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“…As described previously, the TC level after 1 month of steroid treatment was signiicantly higher in patients with asymptomatic ION. Our data are similar to those reported previously [46]. In the early phase, lipids-especially TG-play an important role in the development of ION in patients with SLE.…”

Section: Lipid Levels Statins and Ionsupporting

confidence: 82%

Idiopathic Osteonecrosis and Atypical Femoral Fracture in Systemic Lupus Erythematosus

Kuroda¹,

Sato²

2017

Lupus

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Osteonecrosis and osteoporosis are frequent adverse efects of glucocorticoid therapy of systemic lupus erythematosus (SLE). Idiopathic osteonecrosis (ION) of the femoral head occurs in 3-40% of patients receiving glucocorticoid, and can also develop in other bones. Higher doses of glucocorticoid and steroid pulse therapy are considered to be risk factors for ION of the femoral head. To analyze these risk factors, it seems important to detect early changes in the femoral head by magnetic resonance imaging and to monitor early clinical events atributable to steroid therapy. Prophylaxis with statins and warfarin remains debatable. The use of glucocorticoid is increase the risk of bone fractures. Bisphosphonate (BP) is used for its prevention and treatment of osteoporosis. Atypical femoral fracture (AFF) has been recently recognized as a complication associated with BP use. AFF is considered to be a form of stress fracture; localized periosteal thickening of the lateral cortex is often present at the fracture site. The thickening has been recently recognized as a complication associated with the use of antiresorptive agents such as BP and denosumab. As long-term BP/glucocorticoid use is a risk factor for beaking in patients with SLE , temporary withdrawal of BP administration should be considered.

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Section: Lipid Levels Statins and Ionsupporting

confidence: 82%

Idiopathic Osteonecrosis and Atypical Femoral Fracture in Systemic Lupus Erythematosus

Kuroda¹,

Sato²

2017

Lupus

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“…The incidence of osteonecrosis of the femoral head (ONFH) has been on the rise in recent years due to the widespread use of steroid medication for immunosuppression, especially in transplant patients and in the treatment of rheumatic diseases [1][2][3]. However, the pathogenesis of steroidinduced ONFH has not yet been identified.…”

Section: Introductionmentioning

confidence: 99%

Effect of pentoxifylline on histopathological changes in steroid-induced osteonecrosis of femoral head: experimental study in chicken

Erken

Ofluoğlu

Aktaş

et al. 2012

International Orthopaedics (SICOT)

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Purpose Pentoxifylline (PTX) is a derivative of methylxanthine and is used in peripheral vascular and cerebrovascular diseases for its effect on the regulation of blood circulation. We investigated whether PTX could be beneficial for femoral head osteonecrosis associated with steroid through these effects. Methods Sixty mature Leghorn type chickens were chosen and divided into three groups. The 25 chickens in group A were given a weekly dose of 3 mg/kg/week methylprednisolone acetate intramuscularly. Four chickens in group B died after the first drug injection and were excluded from the study. Therefore, the remaining 21 chickens in group B were additionally given 25 mg/kg/day pentoxifylline intramuscularly, along with the steroid medication as given in group A. The ten chickens in group C were not given any injections, as they were accepted as the control group. After the sacrifice of the animals at week 14, both femoral heads were taken from each animal. The animals which died along the course of the study also underwent pathological examination but were not a part of the statistical analysis. Results In this study, steroid induced femoral head osteonecrosis has been experimentally observed in chickens after high doses of corticosteroid therapy. The chickens were given pentoxifylline in order to prevent the effects of steroid on bones and bone marrow. The results showed that chickens are suitable osteonecrosis models, and that steroid causes adipogenesis and necrosis in the bone marrow and the death of the subchondral bone. Conclusions The results of this study hint at the assumption that PTX may have a positive benefit on ONFH. PTX seems to minimise the effects of the steroid and reduce the incidence of ONFH.

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“…Only a few reports in the literature have described the assessment of ON in juvenile SLE by MRI, and these studies combined paediatric and adult patients [14,15]. MRI appears to be a useful modality particularly in identifying pre-symptomatic ON lesions.…”

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confidence: 99%

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

Castro¹,

Lederman²,

Terreri³

et al. 2011

BJR

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Objective: This study aimed to estimate the prevalence of osteonecrosis (ON) in juvenile systemic lupus erythematosus (SLE) patients using joint-specific and wholebody MRI; to explore risk factors that are associated with the development of ON; and to evaluate prospectively patients 1 year after initial imaging. Method: Within a 2 year period, we studied 40 juvenile SLE patients (aged 8-18 years) with a history of steroid use of more than 3 months duration. Risk factors including disease activity, corticosteroid use, vasculitis, Raynaud's phenomenon and lipid profile were evaluated. All patients underwent MRI of the hips, knees and ankles using jointspecific MRI. Whole-body STIR (short tau inversion recovery) MRI was performed in all patients with ON lesions. Results: Osteonecrosis was identified in 7 patients (17.5 %) upon joint-specific MRI. Whole-body STIR MRI detected ON in 6 of these 7 patients. There was no significant difference between the ON and non-ON groups in the risk factors studied. One patient had pre-existing symptomatic ON. At 1 year follow-up, the ON lesions had resolved in one patient, remained stable in four and decreased in size in two. No asymptomatic patients with ON developed clinical manifestations. Conclusion: Whole-body STIR MRI may be useful in detecting ON lesions in juvenile SLE patients but larger studies are needed to define its role.

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Very early development of steroid-associated osteonecrosis of femoral head in systemic lupus erythematosus: prospective study by MRI

Cited by 106 publications

References 23 publications

Idiopathic Osteonecrosis and Atypical Femoral Fracture in Systemic Lupus Erythematosus

Idiopathic Osteonecrosis and Atypical Femoral Fracture in Systemic Lupus Erythematosus

Effect of pentoxifylline on histopathological changes in steroid-induced osteonecrosis of femoral head: experimental study in chicken

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

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