Avascular Necrosis in Systemic Lupus Erythematosus Silent Symmetric
Osteonecroses
jOHN II. KLIPPEL. M.D. LYNN I-I. GERBER, M.D. LAWRANCE POLLAK, M.D.* JOHN L DECKER. M.D. fbthf:Sti(i, I\fW~iUlJti
The symptomatic joint disease secondary to avascular necrosis of bone (ANB) in 31 of 375 (8 per cent) patients with systemic lupus erythematosus (SLE) was characterized by polyarticular (90 per cent) and symmetric (83 per cent) involvement. Progressive deterioration requiring orthopedic intervention occurred in ~(35 per cent) patients. No distinguishing clinical or treatment differences were found comparing patients with symptomatic ANB and selected corticosteroid-treated, asymptomatic, control subjects with SLE. Complete roentgenographic surveys revealed symmetric, polyarticular abnormalities of subchondral and cortical bone consistent with ANB in eight of 31(26 per cent] of the control subjects. A positive correlation was found between roentgenograpbic ANB and disease treatment with high doses of corticosteroids. The study suggests that ANB may be present in excess of 30 per cent of the patients with SLE and is most often subclinical, asymptomatic and nonprogressive. Idiopathic avascular necrosis of bone (ANB) is the major cause of chronic joint disease in systemic lupus erythematosus (SLE) affecting an estimated 5 to 10 per cent of patients [l-6]. Studies of predisposing risk factors associated with an increase in the susceptil,ility to ANB have emphasized young patient populations [J], the presence of Raynaud’s, central nervous system and systemic vascular abnormalities [3], and the LW of high doses of corticosteroids 151. In this report WC describe our experience with the complication of ANB in a large series of patients with SLE. The characteristic symptomatic ANB joint disease was found to be a symmetric polyarticular condition that developed early in the course of lupus. A complete roentgenographic survey of control subjects with SLE without recurrent articular symptoms revealed evidence of ANB in a substantial proportion of patients and suggests that clinically apparent disease may constitute as little as nne-fourth of all the patients with SLE who have this complication.
From the Arthritis and Rheumatism Branch, National Institute of Arthritis, Mct
Osteonecroses
jOHN II. KLIPPEL. M.D. LYNN I-I. GERBER, M.D. LAWRANCE POLLAK, M.D.* JOHN L DECKER. M.D. fbthf:Sti(i, I\fW~iUlJti
The symptomatic joint disease secondary to avascular necrosis of bone (ANB) in 31 of 375 (8 per cent) patients with systemic lupus erythematosus (SLE) was characterized by polyarticular (90 per cent) and symmetric (83 per cent) involvement. Progressive deterioration requiring orthopedic intervention occurred in ~(35 per cent) patients. No distinguishing clinical or treatment differences were found comparing patients with symptomatic ANB and selected corticosteroid-treated, asymptomatic, control subjects with SLE. Complete roentgenographic surveys revealed symmetric, polyarticular abnormalities of subchondral and cortical bone consistent with ANB in eight of 31(26 per cent] of the control subjects. A positive correlation was found between roentgenograpbic ANB and disease treatment with high doses of corticosteroids. The study suggests that ANB may be present in excess of 30 per cent of the patients with SLE and is most often subclinical, asymptomatic and nonprogressive. Idiopathic avascular necrosis of bone (ANB) is the major cause of chronic joint disease in systemic lupus erythematosus (SLE) affecting an estimated 5 to 10 per cent of patients [l-6]. Studies of predisposing risk factors associated with an increase in the susceptil,ility to ANB have emphasized young patient populations [J], the presence of Raynaud’s, central nervous system and systemic vascular abnormalities [3], and the LW of high doses of corticosteroids 151. In this report WC describe our experience with the complication of ANB in a large series of patients with SLE. The characteristic symptomatic ANB joint disease was found to be a symmetric polyarticular condition that developed early in the course of lupus. A complete roentgenographic survey of control subjects with SLE without recurrent articular symptoms revealed evidence of ANB in a substantial proportion of patients and suggests that clinically apparent disease may constitute as little as nne-fourth of all the patients with SLE who have this complication.
From the Arthritis and Rheumatism Branch, National Institute of Arthritis, Mct
