Corticosteroid Provoked Avascular Necrosis: A complicacy concerning Systemic Lupus Erythematous

Helan Kurian; Jobin Kunjumon Vilapurathu; R Vijaya Sankar G; Dhanya Paul; Chinnu Roy

doi:10.37022/tjmdr.v1i1.214

Helan Kurian Pharm D Interns, Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, Kerala, India-686661
Jobin Kunjumon Vilapurathu Associate Professor, Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, Kerala, India-686661
G.R Vijaya Sankar Associate Professor, Departement of Pharmaceutical Sciences, Vinayaka Missions College of Pharmacy, Salem, Tamilnadu, India-636308
Dhanya Paul Pharm D Interns, Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, Kerala, India-686661
Chinnu Roy Pharm D Interns, Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, Kerala, India-686661

DOI https://doi.org/10.37022/tjmdr.v1i1.214

Abstract

Avascular necrosis (AVN) is the complete death of bone, due to loss of blood flow to the bone. Corticosteroid therapy is the second most significant factor for AVN, and systemic lupus erythematosus (SLE) is the most prevalent underlying disease. Conventional management of AVN entails reduction of weight, complete bed-rest, trimming down the dose of glucocorticoid or abdicating the drug completely. A 19-year old female with a known history of SLE, on methylprednisolone for 2-years, came to the orthopedics outpatient department for pain in her right pelvis. On detailed examination, she was diagnosed with avascular necrosis. The AVN developed as a result of corticosteroid therapy because for the initial 12 months she was on methylprednisolone >20 mg/day (exceeded daily dose). The physician instructed her; complete offload and a trial of bisphosphonate plus aspirin plus statin was given and awaited for revascularization. If the revascularization fails, the physician would suggest total hip replacement.

Keywords: Avascular, corticosteroid, osteonecrosis, femoral head collapse, revascularization

References

Chan K, Mok C. Glucocorticoid-Induced Avascular Bone Necrosis: Diagnosis and Management. The Open Orthopaedics Journal. 2012;6(1):449-457.

Joo Y, Sung Y, Shim J, Kim J, Lee E, Lee H et al. Prevalence, incidence, and associated factors of avascular necrosis in Korean patients with systemic lupus erythematosus: a nationwide epidemiologic study. Rheumatology International. 2014;35(5):879-886.

DOGAN I, KALYONCU U, KILIÇ L, AKDOĞAN A, KARADAĞ Ö, KİRAZ S et al. Avascular necrosis less frequently found in systemic lupus erythematosus patients with the use of alternate-day corticosteroid. TURKISH JOURNAL OF MEDICAL SCIENCES. 2020;.

Amin Kerachian M, Cournoyer D, Harvey E, Chow T, Bégin L, Nahal A et al. New insights into the pathogenesis of glucocorticoid-induced avascular necrosis: microarray analysis of gene expression in a rat model. Arthritis Research & Therapy. 2010;12(3): R124.

Beaulé P, Amstutz H. Management of Ficat Stage III and IV Osteonecrosis of the Hip. Journal of the American Academy of Orthopaedic Surgeons. 2004;12(2):96-105.

Drescher W, Schlieper G, Floege J, Eitner F. Steroid-related osteonecrosis--an update. Nephrology Dialysis Transplantation. 2011;26(9):2728-2731.

Albers A, Carli A, Routy B, Harvey E, Séguin C. Treatment with acetylsalicylic acid prevents short to mid-term radiographic progression of nontraumatic osteonecrosis of the femoral head: a pilot study. Canadian Journal of Surgery. 2015;58(3):198-205.

Wang J. Evidence for Using Alendronate to Treat Adult Avascular Necrosis of the Femoral Head: A Systematic Review. Medical Science Monitor. 2014;20:2439-2447.

Pritchett J. Statin Therapy Decreases the Risk of Osteonecrosis in Patients Receiving Steroids. Clinical Orthopaedics and Related Research. 2001;386:173-178.

Wang G, Cui Q, Balian G. The Pathogenesis and Prevention of Steroid Induced Osteonecrosis. Clinical Orthopaedics and Related Research. 2000;370:295-310.