title: Silent osteonecrosis of the femoral head following high-dose corticosteroids in patients with systemic rheumatic diseases.
abstract: BACKGROUND
  Osteonecrosis (ON) is known to be one of the most disabling complications following corticosteroid (CS) medications. However, evidence regarding risk of asymptomatic prevalence of ON among different diseases and the impact of variable steroid regimens are conflicting. We aimed to determine the prevalence of ON of femoral head in asymptomatic patients with systemic rheumatic diseases who received high-dose CS and also clarify its relationship with different dosages and regimens.
  
  
  METHODS
  In this cross-sectional study, 50 consecutive patients receiving high-dose CS for rheumatic diseases who have no pelvic pain were recruited. MRI of both hips was performed on all patients using a 1.5 Tesla to diagnose ON.
  
  
  RESULTS
  Of 50 subjects, 18 (36%) developed ON of the femoral head. Groups with and without ON were comparable in terms of sex, age and mean starting CS dose. There was no statistical difference in the type of CS regimen including daily dose, peak dose and cumulative dose between the two groups. However, silent ON was associated with both the cumulative CS dose and the duration of CS therapy.
  
  
  CONCLUSIONS
  According to high prevalence of ON in our selected patients with no other identifiable risk factor for ON, monitoring of high risk patients with periodic hip MRI would help diagnose necrosis in early stage.
authors.affiliation: Associate Professor of Rheumatology, Internal Medicine Department, Rheumatology Division, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. kianmehrnahid@gmail.com.
authors.forename: Nahid
authors.initials: N
authors.lastname: Kianmehr
authors.affiliation: Associate Professor of Rheumatology, Emergency Medicine Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. emdaxb@yahoo.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Bidari
authors.affiliation: Associate Professor of Emergency Medicine, Emergency Medicine Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. manimofidi@yahoo.com.
authors.forename: Mani
authors.initials: M
authors.lastname: Mofidi
authors.affiliation: MD, Internal Medicine Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. nassimbahar2000@yahoo.com.
authors.forename: Nasim
authors.initials: N
authors.lastname: Bahar
keywords: Corticosteroid; Silent Osteonecrosis; Systemic rheumatic diseases