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[Recurrent avascular bone necrosis in systemic lupus].

M Abu-Shakra, S Sukenik, Y Shoenfeld

|February 15, 1989

Summary

Aseptic necrosis, a bone condition, often occurs in patients with systemic lupus erythematosus (SLE) during corticosteroid treatment. This case highlights its occurrence in the shoulders, a less common site, emphasizing the need for vigilance.

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Area of Science:

Rheumatology
Orthopedics
Internal Medicine

Background:

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease.
Corticosteroid therapy is a cornerstone in managing SLE but is associated with potential complications.
Ischemic bone necrosis, also known as avascular necrosis, is a recognized complication, frequently affecting the hip.

Observation:

A 21-year-old male diagnosed with SLE presented with bilateral shoulder pain.
The patient had a history of SLE involving skin, joints, brain, small intestine, and kidneys, and was undergoing corticosteroid treatment.
He previously experienced severe knee pain, diagnosed as aseptic necrosis of the femur and tibia via bone scan.

Findings:

The patient developed bilateral shoulder pain with limited range of motion.
Radiographic examination confirmed bilateral ischemic necrosis of the shoulder joints.
This presentation is notable as shoulder involvement is less common than hip necrosis in SLE patients on corticosteroids.

Implications:

Aseptic necrosis should be strongly suspected in SLE patients experiencing arthralgia, particularly during corticosteroid therapy.
Early recognition and diagnosis of bone necrosis are crucial for appropriate management and preventing further joint damage.
This case underscores the importance of considering less common sites of ischemic necrosis in SLE patients.

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