IMAGING STUDY ON THE MODE OF DEVELOPMENT AND CHANGES IN AVASCULAR NECROSIS OF THE FEMORAL HEAD IN SYSTEMIC LUPUS ERYTHEMATOSUS: LONG-TERM OBSERVATIONS

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Abstract
To find out when and how avascular necrosis of the femoral head (ANFH) develops in patients with SLE who are receiving corticosteroids, we carried outa 3-yr prospective study using imaging methods. Twenty-three patients with SLE who were free of hip pain and radiographically negative were enrolled in the study. Initially, abnormal findings characteristic of ANFH were detected in eight (35%) and six (26%) patients on MRI and radionuclide uptake bone scanning, respectively. During a 3-yr observation period abnormalities on MRI, bone scanning and radiography were found in four, fiveand four patients, respectively and three patients developed hip pain. Analyses of imaging changes demonstrated that only a small proportion of patients (2/8, 25%) who initially showed abnormal MRI progressed to beradiographically positive for ANFH over the 3 years. High doses of corticosteroids over the 3-yr period were found to be responsible for the emergence of change in MRI abnormalities. It is also suggested that abnormal MRI findings tend to develop either within a relatively short interval after the start of corticosteroid treatment or are associated with the exacerbation of SLE.

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