Abstract
The pathogenesis of avascular necrosis of bone (ANB) was investigated in 111 patients with systemic lupus erythematosus (SLE) (24 with ANB, 87 without ANB); patients' ages, corticosteroid treatment, clinical and laboratory features associated with SLE, and haemostatic profiles were all taken into account. The mean ages of patients with and without ANB at the time of diagnosis of SLE was 24.1 and 31.2 years respectively. The mean maximal daily dose of prednisolone in the group with ANB was 50.8 mg, which was significantly higher than the dose (41.8 mg) in the group without ANB. Disease features of SLE, such as Raynaud's phenomenon, hyperlipidaemia, nephrotic syndrome, hypertension, and disease activity, were not found to be related to ANB. The percentage of patients who had lupus anticoagulant as well as a shorter activated partial thromboplastin time was greater in those with ANB than in those without. Multiple factors may be involved in the pathogenesis of ANB in SLE, and it is suggested that haemostatic abnormalities, which could be influenced by corticosteroids and young ages, play some part in the development of ANB.
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Selected References
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- Abeles M., Urman J. D., Rothfield N. F. Aseptic necrosis of bone in systemic lupus erythematosus. Relationship to corticosteroid therapy. Arch Intern Med. 1978 May;138(5):750–754. [PubMed] [Google Scholar]
- BOWIE E. J., THOMPSON J. H., Jr, PASCUZZI C. A., OWEN C. A., Jr THROMBOSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS DESPITE CIRCULATING ANTICOAGULANTS. J Lab Clin Med. 1963 Sep;62:416–430. [PubMed] [Google Scholar]
- Bergstein J. M., Wiens C., Fish A. J., Vernier R. L., Michael A. Avascular necrosis of bone in systemic lupus erythematosus. J Pediatr. 1974 Jul;85(1):31–35. doi: 10.1016/s0022-3476(74)80281-7. [DOI] [PubMed] [Google Scholar]
- Boettcher W. G., Bonfiglio M., Hamilton H. H., Sheets R. F., Smith K. Non-traumatic necrosis of the femoral head. I. Relation of altered hemostasis to etiology. J Bone Joint Surg Am. 1970 Mar;52(2):312–321. [PubMed] [Google Scholar]
- Boey M. L., Colaco C. B., Gharavi A. E., Elkon K. B., Loizou S., Hughes G. R. Thrombosis in systemic lupus erythematosus: striking association with the presence of circulating lupus anticoagulant. Br Med J (Clin Res Ed) 1983 Oct 8;287(6398):1021–1023. doi: 10.1136/bmj.287.6398.1021. [DOI] [PMC free article] [PubMed] [Google Scholar]
- COSGRIFF S. W. Thromboembolic complications associated with ACTH and cortisone therapy. J Am Med Assoc. 1951 Nov 3;147(10):924–926. doi: 10.1001/jama.1951.03670270014006. [DOI] [PubMed] [Google Scholar]
- Colaco C. B., Elkon K. B. The lupus anticoagulant. A disease marker in antinuclear antibody negative lupus that is cross-reactive with autoantibodies to double-stranded DNA. Arthritis Rheum. 1985 Jan;28(1):67–74. doi: 10.1002/art.1780280111. [DOI] [PubMed] [Google Scholar]
- DUBOIS E. L., COZEN L. Avascular (aseptic) bone necrosis associated with systemic lupus erythematosus. JAMA. 1960 Oct 22;174:966–971. doi: 10.1001/jama.1960.03030080028005. [DOI] [PubMed] [Google Scholar]
- Dorsch C. A., Meyerhoff J. Mechanisms of abnormal platelet aggregation in systemic lupus erythematosus. Arthritis Rheum. 1982 Aug;25(8):966–973. doi: 10.1002/art.1780250809. [DOI] [PubMed] [Google Scholar]
- FREIBERGER R. H., SWANSON G. E. ASEPTIC NECROSIS OF THE FEMORAL HEADS AFTER HIGH-DOSAGE CORTICOSTEROID THERAPY. N Y State J Med. 1965 Mar 15;65:800–804. [PubMed] [Google Scholar]
- Fisher D. E., Bickel W. H., Holley K. E. Histologic demonstration of fat emboli in aseptic necrosis associated with hypercortisonism. Mayo Clin Proc. 1969 Apr;44(4):252–259. [PubMed] [Google Scholar]
- Goldie I., Tibblin G., Scheller S. Systemic lupus erythematosus (SLE) and aseptic bone necrosis. A discussion based on the presentation of one case treated with corticosteroids. Acta Med Scand. 1967 Jul;182(1):55–63. [PubMed] [Google Scholar]
- HEIMANN W. G., FREIBERGER R. H. Avascular necrosis of the femoral and humeral heads after high-dosage corticosteroid therapy. N Engl J Med. 1960 Oct 6;263:672–675. doi: 10.1056/NEJM196010062631404. [DOI] [PubMed] [Google Scholar]
- Harrington K. D., Murray W. R., Kountz S. L., Belzer F. O. Avascular necrosis of bone after renal transplantation. J Bone Joint Surg Am. 1971 Mar;53(2):203–215. [PubMed] [Google Scholar]
- Homcy C. J., Liberthson R. R., Fallon J. T., Gross S., Miller L. M. Ischemic heart disease in systemic lupus erythematosus in the young patient: report of six cases. Am J Cardiol. 1982 Feb 1;49(2):478–484. doi: 10.1016/0002-9149(82)90528-8. [DOI] [PubMed] [Google Scholar]
- Hurley R. M., Steinberg R. H., Patriquin H., Drummond K. N. A vascular necrosis of the femoral head in childhood systemic lupus erythematosus. Can Med Assoc J. 1974 Oct 19;111(8):781–784. [PMC free article] [PubMed] [Google Scholar]
- Kalla A. A., Learmonth I. D., Klemp P. Early treatment of avascular necrosis in systemic lupus erythematosus. Ann Rheum Dis. 1986 Aug;45(8):649–652. doi: 10.1136/ard.45.8.649. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Klipper A. R., Stevens M. B., Zizic T. M., Hungerford D. S. Ischemic necrosis of bone in systemic lupus erythematosus. Medicine (Baltimore) 1976 May;55(3):251–257. doi: 10.1097/00005792-197605000-00004. [DOI] [PubMed] [Google Scholar]
- Murray W. R. Hip problems associated with organ transplants. Clin Orthop Relat Res. 1973 Jan-Feb;(90):57–69. [PubMed] [Google Scholar]
- RUDERMAN M., MCCARTY D. J., Jr ARTHRITIS ROUNDS. (4). ASEPTIC NECROSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS. REPORT OF A CASE INVOLVING SIX JOINTS. Arthritis Rheum. 1964 Dec;7:709–717. doi: 10.1002/art.1780070611. [DOI] [PubMed] [Google Scholar]
- Regan M. G., Lackner H., Karpatkin S. Platelet function and coagulation profile in lupus erythematosus. Studies in 50 patients. Ann Intern Med. 1974 Oct;81(4):462–468. doi: 10.7326/0003-4819-81-4-462. [DOI] [PubMed] [Google Scholar]
- Smith F. E., Sweet D. E., Brunner C. M., Davis J. S., 4th Avascular necrosis in SLE. An apparent predilection for young patients. Ann Rheum Dis. 1976 Jun;35(3):227–232. doi: 10.1136/ard.35.3.227. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tan E. M., Cohen A. S., Fries J. F., Masi A. T., McShane D. J., Rothfield N. F., Schaller J. G., Talal N., Winchester R. J. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982 Nov;25(11):1271–1277. doi: 10.1002/art.1780251101. [DOI] [PubMed] [Google Scholar]
- Tanaka K., Masuda J., Imamura T., Sueishi K., Nakashima T., Sakurai I., Shozawa T., Hosoda Y., Yoshida Y., Nishiyama Y. A nation-wide study of atherosclerosis in infants, children and young adults in Japan. Atherosclerosis. 1988 Aug;72(2-3):143–156. doi: 10.1016/0021-9150(88)90075-5. [DOI] [PubMed] [Google Scholar]
- Zizic T. M., Marcoux C., Hungerford D. S., Dansereau J. V., Stevens M. B. Corticosteroid therapy associated with ischemic necrosis of bone in systemic lupus erythematosus. Am J Med. 1985 Nov;79(5):596–604. doi: 10.1016/0002-9343(85)90057-9. [DOI] [PubMed] [Google Scholar]