Incidence of osteonecrosis associated with corticosteroid therapy among different underlying diseases: prospective MRI study

Shigemura, Tomonori; Nakamura, Junichi; Kishida, Shunji; Harada, Yoshitada; Ohtori, Seiji; Kamikawa, Koya; Ochiai, Nobuyasu; Takahashi, Kazuhisa

doi:10.1093/rheumatology/ker277

Cited by 143 publications

(110 citation statements)

References 15 publications

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“…In the 1,502 patients whose detailed information was available, the potential causative factors of ONFH were largely attributable to systemic steroid administration (51 %), with SLE reported most frequently (31 %). Shigemura et al [20] investigated the relationship between underlying disease and risk factors for steroid-associated ONFH in a prospective MRI study. They reported that the incidence of ONFH was significantly higher in the SLE group than in the non-SLE group (37 % vs 21 %, P00.001).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head

Moriya

Uchiyama

Takahira

et al. 2012

International Orthopaedics (SICOT)

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Purpose Bipolar hemiarthroplasty (BHA) for idiopathic osteonecrosis of the femoral head (ONFH) is performed at our institution. The purpose of this study was to evaluate the clinical and radiographic findings after BHA for the treatment of steroid -induced ONFH. Methods Thirty-seven hips in 27 patients were assessed (seven men, 11 hips; 20 women, 26 hips), average patient age at the time of surgery of 42.6 (range 20-83) years, with steroid-induced ONFH treated with BHA between 1995 and 2005. The mean follow-up duration was approximately ten (range five to15) years. Patients were evaluated according to the Japan Orthopaedic Association (JOA) hip score. Kaplan-Meier survivorship was calculated to examine revision arthroplasty failure rate. Radiographic analysis of loosening included radiolucent lines and osteolysis of the acetabulum or femur. Causes of loosening were analysed using multiple logistic regression. Result JOA hip score increased from 53 points (preoperative) to 87 points (final follow-up). Survival rates were 96.8 % and 78.6 % at ten and 15 years, respectively. Prosthesis loosening occurred on the acetabular side in five hips (13.5 %). No femoral-component loosening was observed. BHA had poor results in patients with Association Research Circulation Osseous (ARCO) stage IV ONFH and in patients under 40 years of age. Conclusion BHA, with strict surgical indications, may be a good option for treating ONFH. Based on these results, total hip arthroplasty is recommended for patients with ARCO stage IV ONFH or for patients under 40 years of age.

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Section: Discussionmentioning

confidence: 99%

Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head

Moriya

Uchiyama

Takahira

et al. 2012

International Orthopaedics (SICOT)

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“…7,8,[10][11][12] Glucocorticoid-induced osteonecrosis also complicates treatment of nonmalignant conditions such as solid organ transplant and arthritis. [13][14][15] Osteonecrosis can result in debilitation and adversely affect quality of life, often requiring surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

Genetics of glucocorticoid-associated osteonecrosis in children with acute lymphoblastic leukemia

Karol¹,

Yang

Driest

et al. 2015

Blood

103

111

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“…One of the main factors of predisposition to AVN is the presence of anti-phospholipid antibodies (APA) and/or anti-phospholipid syndrome. In a one-year prospective magnetic resonance imaging (MRI) study of 687 joints in patients with SLE, the risk factors for the increase in the incidence of AVN in comparison to patients with other autoimmune diseases such as myositis, medium-and large-vessel vasculitides, pemphigoid, RA, scleroderma and Behcet's disease were adult and adolescent patients (OR = 13.2), high glucocorticoid dose of more than 40 mg/d of prednisolone equivalent (OR = 4.2), patients with SLE (OR = 2.6) and the male sex (OR = 1.6) [21] . Treatment of AVN depends on the stage of the disease, the severity of the involvement of AVN, pain severity and the presence of co-morbidities which may pose patients to higher risks for major operation and anesthesia [23] .…”

Section: Fragility Fracturementioning

confidence: 99%

“…AVN AVN or osteonecrosis is not an uncommon phenomenon in SLE patients. Amongst all rheumatic diseases, the prevalence of AVN is the highest in patients with SLE, as compared with patients with other rheumatological conditions such as autoimmune myositis, vasculitides, rheumatoid arthritis (RA) and systemic sclerosis [21] . In one of the oldest studies, 4.6% of patients with SLE were found to develop AVN [22] .…”

Section: Fragility Fracturementioning

confidence: 99%

Orthopedic surgery and its complication in systemic lupus erythematosus

Mak¹

2014

WJO

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Systemic lupus erythematosus (SLE) is a multi-systemic immune-complex mediated autoimmune condition which chiefly affects women during their prime year. While the management of the condition falls into the specialty of internal medicine, patients with SLE often present with signs and symptoms pertaining to the territory of orthopedic surgery such as tendon rupture, carpal tunnel syndrome, osteonecrosis, osteoporotic fracture and infection including septic arthritis, osteomyelitis and spondylodiscitis. While these orthopedicrelated conditions are often debilitating in patients with SLE which necessitate management by orthopedic specialists, a high index of suspicion is necessary in diagnosing these conditions early because lupus patients with potentially severe orthopedic conditions such as osteomyelitis frequently present with mild symptoms and subtle signs such as low grade fever, mild hip pain and back tenderness. Additionally, even if these orthopedic conditions can be recognized, complications as a result of surgical procedures are indeed not uncommon. SLE per se and its various associated pharmacological treatments may pose lupus patients to certain surgical risks if they are not properly attended to and managed prior to, during and after surgery. Concerted effort of management and effective communication among orthopedic specialists and rheumatologists play an integral part in enhancing favorable outcome and reduction in postoperative complications for patients with SLE through thorough pre-operative evaluation, careful peri-operative monitoring and treatment, as well as judicious postoperative care.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: orthopedics; Complications; Surgery; Systemic lupus erythematosus; operation Core tip: Systemic lupus erythematosus (SLE) is a complex autoimmune condition. orthopedic specialists often encounter patients with SLE presenting with various orthopedic conditions which require surgical intervention but due to the complexity of SLE and its associated treatment, pre-operative preparation and post-operative care for these patients are often challenging. Concerted effort of management and effective communication between orthopedic specialists and rheumatologists play an integral part in enhancing favorable outcome and reduction in postoperative complications for patients with SLE through thorough preoperative evaluation, careful peri-operative monitoring and treatment, as well as judicious postoperative care.Mak A. Orthopedic surgery and its complication in systemic lupus erythematosus.

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Incidence of osteonecrosis associated with corticosteroid therapy among different underlying diseases: prospective MRI study

Abstract: These findings suggest that the incidence of CS-associated osteonecrosis varies among different underlying diseases.

Cited by 143 publications

References 15 publications

Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head

Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head

Genetics of glucocorticoid-associated osteonecrosis in children with acute lymphoblastic leukemia

Orthopedic surgery and its complication in systemic lupus erythematosus

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