title: Temporal course of avascular femoral head necrosis in patients with pemphigus vulgaris.
abstract: OBJECTIVE
  Pemphigus vulgaris (PV) is typically treated with systemic corticosteroids and immunosuppressive agents. Avascular necrosis (AVN) of the femoral head is a well-recognized major complication of corticosteroid therapy. The characteristics of this serious complication in PV remain unknown.
  
  
  METHODS
  Uncontrolled, retrospective study of all PV-related AVN cases diagnosed at an Iranian autoimmune bullous disease clinic between 1985 and 2013.
  
  
  RESULTS
  Of the 2,321 medical records of PV patients reviewed, 45 (1.93 %) cases showed femoral AVN, with 30 (66.7 %) individuals being male. The mean age at diagnosis of AVN was 47.4 ± 14.2 years. The mean interval between the diagnosis of PV and the onset of AVN was 25.3 ± 18.3 months. With the exception of eight cases (17.8 %), the majority of patients developed AVN within three years after the diagnosis of PV. The mean cumulative dose of prednisolone in patients with AVN was 13,115.8 ± 7041.1 mg. There was a strong correlation between the total prednisolone dose and the time of onset of AVN (p = 0.001). In patients with a history of alendronate intake, that interval was significantly shorter (p = 0.01).
  
  
  CONCLUSIONS
  Occurring in about 2 % of patients, AVN is a serious complication of corticosteroid treatment in patients with PV, predominantly in the first three years of treatment. In individuals receiving higher doses of prednisolone, AVN tends to occur earlier.
authors: Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors: Kamran
authors: K
authors: Balighi
authors: Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors: Maryam
authors: M
authors: Daneshpazhooh
authors: Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. nessa.a@gmail.com, n-aghazadeh@sina.tums.ac.ir.
authors: Nessa
authors: N
authors: Aghazadeh
authors: Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors: Vahide
authors: V
authors: Saeidi
authors: Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors: Farzam
authors: F
authors: Shahpouri
authors: Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors: Pardis
authors: P
authors: Hejazi
authors: Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors: Cheyda
authors: C
authors: Chams-Davatchi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D017677:Age Distribution; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D015984:Causality; D015897:Comorbidity; D003879:Dermatologic Agents / Q000008:administration & dosage; D018450:Disease Progression; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005271:Femur Head Necrosis / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents