Main Article Content

Abstract

According to the 1993 Association Research Circulation Osseous, idiopathic avascular necrosis of the femoral head is defined as the presence of disease or other causes that result in ischemic osteonecrosis of the femoral head without the presence of trauma or sepsis. Based on the above defi nition, idiopathic avascular necrosis
(AVN) includes those that are the result of steroid administration, systemic lupus erythematosus, alcoholic consumption, etc. The pathogenesis of AVN is still obscure; however, it is basically caused by vascular circulation disorder, cell death and decreased capability of bone repair.1,2 Systemic lupus erythematosus (SLE) is characterized by the presence of systemic immune dysregulation, autoantibody formation, immune complex in the circulation, and activation of the systemic complement. The pathology during recurrence of SLE, among others, is the presence
of vascular lesion in the form of infl ammation, thrombosis, endothelial injury in which the three of them are predispositions for atherosclerosis. The vascular lesion will cause microcirculation damage which is a risk factor for the occurrence of AVN in activation of SLE. Besides being caused by vascular lesion during activation of SLE, AVN is also triggered by fat deposition in SLE patients as a result of long term steroid therapy that causes abnormal blood fat level.1,2 Patients with SLE who have undergone pharmacologic treatment with systemic steroid either in oral or injection form will have 10 to 40 times the risk of having idiopathic AVN. High dose of systemic steroid treatment of more than 4000 mg of prednisone administered for more than three months or low dose of oral steroid administered for seven days can become a risk factor for AVN. The mechanism of AVN caused by steroid treatment
is associated with hypercoagulation, fi brinolysis disorder, and thrombosis of the bone vein.1,2,3 We report a case of AVN of the right femoral head in an SLE patient.

Article Details

How to Cite
Manuaba, I. A. R. W., & Setiyohadi, B. (2018). Avascular necrosis of the right femoral head in a systemic lupus erythematosus patient. Indonesian Journal of Rheumatology, 1(1). https://doi.org/10.37275/ijr.v1i1.16

References

  1. Rizzo M., Urbaniak JR. Osteonecrosis. In: Kelly’s Textbook of Rheumatology. Harris ED, Budd RC, Genovese MC, et al.7th ed, vol II;2005:1812-25.
  2. Healey JH, Piccioli A. Osteonecrosis. In: Manual of Rheumatology and
  3. Outpatient Orthopedic Disorders Diagnosis and Therapy. Paget SA,
  4. Gibofsky A, Beary III JF, Sculco TP.5th ed;2006:393-7.
  5. Fen Liu Y, Ming Chen W, Feng Lin Y, Cheng Yang R, Wei Lin M, Hui Li
  6. L et al. Type II Collagen Gene Variatnts and Inherited Osteonecrosis
  7. of The Femoral Head. N Engl J Med 2005;352:2294-301.
  8. McKee MD, Waddell JP, Kudo PA, Schemitsch EH, Richards RR. Osteonecrosis of the femoral head in men following short-course
  9. corticosteroid therapy: a report of 15 cases. CMAJ 2001;23:164.
  10. Loddenkemper K, Perka C, Burmester G-R, Buttgereit F. Coincidence
  11. of asymptomatic avascular necrosis and fracture of the femoral neck:
  12. a rare combination of glucocorticoid induced side effects. Ann Rheum
  13. Dis 2002;61:665–666.
  14. K Oinuma, Y Harada, Y Nawata, K Takabayashi, I Abe, K Kamikawa, H
  15. Moriya. Osteonecrosis in patients with systemic lupus erythematosus
  16. develops very early after starting high dose corticosteroid treatment.
  17. Ann Rheum Dis 2001;60:1145–1148.
  18. Markisz JA, Knowles JR, Altchek DW, Schneider R, Whalen JP, Cahill
  19. JP Segmental Patterns of Avascular Necrosis of the Femoral Heads:
  20. Early Detection with MR Imaging. Radiology 1987; 162:717-720.
  21. Hernigou Ph, Lambotte JC. Bilateral hip osteonecrosis: infl uence of
  22. hip size on outcome. Ann Rheum Dis 2000;59:817–821.
  23. Kakaria B HL, Sharma C AK, Sebastian B. Total Hip Replacement in
  24. Avascular Necrosis of Femoral Head. MJAFI 2005; 61 : 33-35.
  25. Kawate K, Yajima H, Sugimoto K, Ono H, Ohmura T, Kobata Y, et al.
  26. Indications for free vascularized fi bular grafting for the treatment of
  27. osteonecrosis of the femoral head. BMC Musculoskeletal Disorders
  28. , 8:78 doi:10.1186/1471-2474-8-78