Corticosteroid Provoked Avascular Necrosis: A complicacy concerning Systemic Lupus Erythematous

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.