Osteonecrosis in Systemic Lupus Erythematosus: An Early, Frequent, and Not Always Symptomatic Complication

Paola Caramaschi; Domenico Biasi; Ilaria Dal Forno; Silvano Adami

doi:10.1155/2012/725249

journal article Open Access Jan 01, 2012

Osteonecrosis in Systemic Lupus Erythematosus: An Early, Frequent, and Not Always Symptomatic Complication

Paola Caramaschi Domenico Biasi Ilaria Dal Forno Silvano Adami

Autoimmune Diseases Vol. 2012 pp. 1-7 · Wiley

View at Publisher Save 10.1155/2012/725249

Abstract

Osteonecrosis may complicate the course of systemic lupus erythematosus and may contemporaneously affect multiple joints. The major risk factor associated with the development of osteonecrosis is the use of glucocorticoid at high doses. Recent studies using serial MRI, which represents the “gold standard” for the early detection of osteonecrosis, yielded some interesting findings about the natural history of this clinical entity. Osteonecrosis in the majority of the cases is asymptomatic and occurs early in the course of the disease. Its later occurrence is associated with lupus flare that requires the increase of corticosteroid dose. The optimal treatment of osteonecrosis is controversial. In case of silent osteonecrosis involving a small area conservative strategy is usually adequate. When lesions are symptomatic surgical treatment as core decompression or free vascularized fibular grafting is required; extracorporeal shockwave treatment may represent an alternative therapeutic approach. When the lesion has a medium-large dimension or involves a weight-bearing area bone collapse is a common complication requiring total joint replacement. Coadministration of bisphosphonate or warfarin with high doses of corticosteroid might be a promising preventive strategy of osteonecrosis.

Topics

No keywords indexed for this article. Browse by subject →

References

68

[1]

10.1016/j.jbspin.2006.01.025

[2]

10.1385/criai:25:1:13

[3]

10.1007/s007760200108

[4]

Journal of Rheumatology (2001)

[5]

British Journal of Rheumatology (1998) 10.1093/rheumatology/37.8.895

[6]

Lupus (1996) 10.1177/096120339600500414

[7]

10.1001/archinte.138.5.750

[8]

Journal of Rheumatology (1997)

[9]

Journal of Rheumatology (1989)

[10]

10.1136/ard.59.6.462

[11]

10.1097/rhu.0b013e3181ba3423

[12]

American Journal of Medicine (1979) 10.1016/0002-9343(79)90077-9

[13]

Annals of the Rheumatic Diseases (1986) 10.1136/ard.45.8.649

[14]

Journal of Rheumatology (1993)

[15]

American Journal of Orthopedics (1998)

[16]

Journal of Rheumatology (2001)

[17]

10.1136/ard.60.12.1145

[18]

Annals of the Rheumatic Diseases (1985) 10.1136/ard.44.1.65

[19]

10.1016/s0899-7071(03)00192-x

[20]

British Journal of Rheumatology (1994) 10.1093/rheumatology/33.4.343

[21]

10.2106/jbjs.i.00575

[22]

Lupus (2009) 10.1177/0961203309345795

[23]

10.1038/ncprheum0298

[24]

10.1002/art.11487

[25]

10.1074/jbc.m100878200

[26]

Journal of Bone and Mineral Research (2001) 10.1359/jbmr.2001.16.1.182

[27]

Journal of Rheumatology (2003)

[28]

Clinical Orthopaedics and Related Research (2001)

[29]

10.1111/j.1365-2141.2005.05476.x

[30]

Revue du Rhumatisme et des Maladies Osteo-Articulaires (1972)

[31]

10.1002/1529-0131(199907)42:7<1405::aid-anr14>3.0.co;2-w

[32]

10.1007/s11999-010-1292-x

[33]

10.1007/s00776-009-1439-3

[34]

10.1016/j.jhsa.2011.09.028

[35]

Rheumatology (2011) 10.1093/rheumatology/ker277

[36]

10.1016/j.bone.2009.06.030

[37]

Israel Medical Association Journal (2009)

[38]

10.1691/ph.2007.12.7583

[39]

10.1097/00008571-200311000-00003

[40]

British Journal of Rheumatology (1998) 10.1093/rheumatology/37.4.448

[41]

10.1177/0961203306075771

[42]

10.1002/1529-0131(200008)43:8<1801::aid-anr16>3.0.co;2-o

[43]

10.1177/0961203307076771

[44]

10.1136/ard.2005.040428

[45]

Lupus (1992) 10.1177/096120339200100610

[46]

American Journal of Medicine (1985) 10.1016/0002-9343(85)90057-9

[47]

Clinical Orthopaedics and Related Research (1989)

[48]

10.1002/art.27236

[49]

Journal of Bone and Joint Surgery A (1979) 10.2106/00004623-197961060-00008

[50]

Lupus (1994) 10.1177/096120339400300108

Showing 50 of 68 references

Metrics

11

Citations

68

References

Details

Published: Jan 01, 2012
Vol/Issue: 2012
Pages: 1-7
License: View

Authors

P

Paola Caramaschi

Rheumatology Unit, Department of Medicine, University of Verona, 37134 Verona, Italy

D

Domenico Biasi

Rheumatology Unit, Department of Medicine, University of Verona, 37134 Verona, Italy

I

Ilaria Dal Forno

Rheumatology Unit, Department of Medicine, University of Verona, 37134 Verona, Italy

S

Silvano Adami

Rheumatology Unit, Department of Medicine, University of Verona, 37134 Verona, Italy

Cite This Article

Paola Caramaschi, Domenico Biasi, Ilaria Dal Forno, et al. (2012). Osteonecrosis in Systemic Lupus Erythematosus: An Early, Frequent, and Not Always Symptomatic Complication. Autoimmune Diseases, 2012, 1-7. https://doi.org/10.1155/2012/725249

Osteonecrosis in Systemic Lupus Erythematosus: An Early, Frequent, and Not Always Symptomatic Complication

You May Also Like