Multiple avascular necrosis of bone and polyarticular septic arthritis in patients with systemic lupus erythematosus.
OBJECTIVE
Avascular necrosis of bone (AVN) and osteoarticular infection share similar risk factors in systemic lupus erythematosus (SLE) patients. However, their coincidental development in SLE has rarely been described. We describe four cases of AVN complicated by Staphylococcus aureus infection in SLE.


METHODS
Patients were identified by retrospectively reviewing an SLE cohort followed between 1979 and 2003. A review of the literature from 1960 until 2003 was also done.


RESULTS
Among 315 SLE patients, four developed joint infection by S. aureus following or coincidentally with AVN. All presented multifocal disease with severe or relapsing course, resulting in severe incapacity. The clinical course suggests that AVN developed first in active SLE patients with positive antiphospholipid (aPL) antibodies treated with high-dose corticosteroids (CS), and subsequent bone infarcts favor infection. Our patients often required prolonged antibiotic therapy and surgical treatment.


CONCLUSIONS
Active SLE patients with aPL antibodies on high-dose CS seem at high risk of developing multiple AVN complicated by infection. Avascular necrosis and bone or joint infection by S. aureus in these patients is a major complication that leads to severe joint destruction and disability.
Servicio de Reumatología, Hospital 12 de Octubre, Carretera de Andalucía, Km 5.4, 28041, Madrid, Spain. reuma@h12o.es
María
M
Galindo
Isabel
I
Mateo
José L
JL
Pablos
D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood; D001170:Arthritis, Infectious / Q000150:complications / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D010020:Osteonecrosis / Q000150:complications / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications / Q000473:pathology; D013211:Staphylococcus aureus / Q000302:isolation & purification / Q000502:physiology
D017152:Antibodies, Antiphospholipid