Avascular necrosis in systemic lupus erythematosus patients: Analysis of the demographics, clinical manifestations, management and outcomes

Background: Avascular necrosis (AVN) is a rare complication of systemic lupus erythematosus (SLE) that may develop from the disease or its treatment.Aim of the work: To present the clinical characteristics, management and outcomes of SLE patients with AVN.Patients and methods: The SLE patients with AVN on X-ray or magnetic resonance imaging (MRI) follow-ing up at Fatima Memorial Hospital College of Medicine and Dentistry Shadman, Lahore, Pakistan were studied. Detailed medical history, clinical examination, laboratory investigations, treatment details and outcomes were recorded.Results: Out of 230 SLE patients, 20 (8.6%) had AVN; 80% females, F:M 4:1 with a mean age at onset of SLE 19.8 & PLUSMN; 6.5 years, and mean duration till occurrence of AVN 3.9 & PLUSMN; 2.3 years. AVN developed within 4 years of onset in 80% of patients. Mucocutaneous symptoms were the most common presentation (95%) and 65% had positive antiphospholipid antibodies. Until AVN development, all patients received a mean of 3.5 & PLUSMN; 0.7 g pulse steroid and a mean cumulative oral steroid dose of 18.6 & PLUSMN; 6.2 g. AVN was in the hip joint in 95% of cases, 80% were bilateral. AVN was grade II in 45% patients, grade III in 25% (n = 5), I in 20% (n = 4) and grade IV in 10% (n = 2). Grade I and II had preserved joint function and didn't need any surgery compared to stage III and IV.Conclusions: In SLE patients, AVN is a relatively early complication occurring within 4 years of illness in patients with a young age at onset, and have a better outcome when detected at earlier stages.& COPY; 2023 THE AUTHORS. Publishing services by ELSEVIER B.V. on behalf of The Egyptian Society of Rheu-matic Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).