Spontaneous repair of asymptomatic osteonecrosis associated with corticosteroid therapy in systemic lupus erythematosus: 10-year minimum follow-up with MRI.
Systemic lupus erythematosus (SLE) patients are at high risk of developing osteonecrosis. This study utilized MRI to document the long-term natural history of asymptomatic osteonecrosis associated with corticosteroid therapy in SLE patients. Two hundred and one SLE patients treated with high-dose corticosteroids were prospectively observed from 1986 to 1997. The inclusion criterion was that patients had received periodic MRI examinations of all their hip and knee joints for ≥10 years. Joints that were already collapsed and symptomatic at the first examination were excluded. Five hundred and thirty-seven joints (251 hips and 286 knees) were identified in 144 patients, with a mean follow-up period of 13.6 years (range, 10-20 years) and a follow-up rate of 73%. Mean age of SLE onset was 26 years, and the mean highest oral corticosteroid dosage was 57 mg/day. Osteonecrosis developed in 238 (44%) of 537 joints. At final follow-up, 117 (49%) of these 238 joints demonstrated spontaneous repair in the necrotic area. Osteonecrosis completely disappeared in 21 joints. Enlargement of osteonecrosis was noted in 35 joints (15%) following increased steroid dosage because of SLE recurrence. Finally, 52 joints (22%) were collapsed. Spontaneous repair of asymptomatic osteonecrosis was observed, whereas enlargement occurred only after corticosteroid dosage increases.
Nakamura
J
J
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan. njonedr@yahoo.co.jp
Harada
Y
Y
Oinuma
K
K
Iida
S
S
Kishida
S
S
Takahashi
K
K
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000473:pathology; D006801:Humans; D007719:Knee Joint / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D010020:Osteonecrosis / Q000139:chemically induced* / Q000473:pathology; D011446:Prospective Studies; D014945:Wound Healing; D055815:Young Adult
D000305:Adrenal Cortex Hormones