Purpose Avascular necrosis of bone [AVN] can cause significant disability and limitation of mobility in systemic lupus erythematosus [SLE] patients. Risk factors of AVN include a longer disease duration, high LDL-C, positive aCL IgG and anti-dsDNA, cushingoid body habitus, and the use of corticosteroid. In the absence of steroid use, AVN is extremely rare. Herein, we present an experience of AVN in an SLE patient without use of corticosteroid.
Methods The patient was a 39-year old female, diagnosed at 17 with SLE. She had taken medicines irregularly but her disease status had been relatively stable. She visited our hospital with left hip joint pain. At that time she was taking hydroxychlorquine 200mg/day, losartan 50mg/day, aspirin 100mcg/day and NSAID from another hospital. She denied a history of steroid use. On laboratory testing, ANA was 1:320, anti-dsDNA Ab, anti-Ro/La Ab, and anti-Smith Ab were negative. CBC, liver, and kidney function test were in normal range. LDL-C was 79 mg/dL, ESR was 36 mm/hr, CRP was 0.79 mg/dL. Anti-phospohlipid antibodies were positive (aCL IgG 79.0 GPL, anti-β2 glycoprotein I IgG 142.0 G units, confirmative lupus anticoagulant 1.42). X-ray of hip joint demonstrated marginal irregularity and sclerotic change with central lucency in the head of left femur. We started conservative management of joint pain. After 10 months, she newly complained of bilateral knee pain. X-ray of knee joint demonstrated joint space narrowing in both knees on medial aspect and severe bony sclerotic changes in both lateral condyles of femur.
Results The risk factors for AVN in SLE have been reported by several studies. There is a strong causal relationship between corticosteroid intake and AVN development in SLE patients. However, in this case, the patient had never taken corticosteroid since diagnosis of SLE.
Conclusions The pathophysiology of AVN is not clear yet, however SLE itself should be considered an important risk factor of AVN.
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