Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024141 (systemic lupus erythematosus)
 44,322 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Aseptic necrosis of the metacarpal head is extremely rare and has been described in association with systemic lupus erythematosus, steroid use, trauma, and other sites of bone infarction. The long metacarpal is the most commonly involved. The extrinsic and intrinsic vascular anatomy of the metacarpal is described in fifty metacarpal specimens. No definite conclusions can be drawn about anatomic variations in blood supply between the different metacarpals. However, in 35% of the specimens, a main arteriole in the distal epiphysis was absent, making these metacarpal heads solely dependent on small circumferential pericapsular arterioles. This group of metacarpals, when associated with other risk factors, such as trauma, systemic lupus erythematosus, or steroid use, may be at increased risk for the development of aseptic necrosis.
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PMID:Avascular necrosis and vascular anatomy of the metacarpals. 186 Oct 41

Because the available preliminary data strongly indicate that MRI is accurate in diagnosing osteonecrosis, MRI of the hips is recommended in patients suspected of having osteonecrosis, especially if other diagnostic studies are equivocal. MRI also may be useful in following patients who have strong risk factors for osteonecrosis, such as corticosteroid therapy, femoral neck fracture, traumatic femoral head dislocation (Fig. 13), slipped capital femoral epiphysis (Fig. 14), and congenital hip dislocation. In diseases such as systemic lupus erythematosus, both hips eventually may become involved in 50 to 80 per cent of cases. Therefore, the unaffected hip of patients with systemic lupus erythematosus and unilateral nontraumatic osteonecrosis of the hip should be monitored regularly with MRI. The hope is that early diagnosis and treatment of femoral head osteonecrosis will prevent the relentless progression to subchondral collapse and disabling arthropathy. MRI also may be useful in staging patients known to have osteonecrosis. The ability of MRI to image directly in multiple planes facilitates the determination of the volume and location of infarcted segments of bone. This information is important in planning any of the surgical procedures used relatively early in the disease, such as core decompression, rotational osteotomy, or bone graft. Moreover, MRI may prove helpful in evaluating the effectiveness of any therapeutic intervention.
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PMID:Magnetic resonance imaging of osteonecrosis. 371 96

Ninety consecutive total hip arthroplasties in 73 patients with osteonecrosis of the femoral head yielded 81 hips in 64 patients (37 men and 27 women) available for evaluation after a 4-8-year follow-up period. The average age at surgery was 39.9 years (range, 20-66 years). Osteonecrosis etiology was idiopathic in 13 hips, alcohol-induced in 15, femoral neck fracture in 12, and slipped capital femoral epiphysis in 2. The remaining 39 cases were related to steroids, which were administered for a variety of reasons. Two types of noncemented, porous-coated, straight-stem femoral components and three types of acetabular components were utilized. Good or excellent clinical results were recorded in 80.2% of the patients. Average Harris hip scores improved from 52.9 to 87.9 points. Nine patients required revision of at least one component and were significantly younger than those with unrevised components. A revision rate of 24.1% was recorded in patients under 35 years of age at the time of primary surgery. Good or excellent clinical results were seen in 92.3% of the idiopathic cases, 86.7% of the alcohol-induced cases, 77.8% of the renal transplant cases, and 62.5% of the systemic lupus erythematosus cases. The overall mortality rate at the follow-up evaluation was 14%; it was 50% in renal transplant patients. Analysis of the clinical results based on the implants showed no significant differences in Harris hip scores or pain and function scores. While total hip arthroplasty using noncemented porous-coated femoral stems appears to give better results than cemented procedures in patients with osteonecrosis of the femoral head, the results appear to be inferior to those reported in patients with other diagnoses.
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PMID:Primary total hip arthroplasty using noncemented porous-coated femoral components in patients with osteonecrosis of the femoral head. 780 2

Estrogen deficiency results in increased bone turnover and net bone loss in rats as well as humans. The respective roles of bone turnover and mechanical strain in mediating estrogen deficiency-induced cancellous bone loss were investigated in ovariectomized rats. Ovariectomy resulted in increased bone turnover in long bones. However, cancellous bone was preferentially lost in the metaphysis, a site that experiences low strain energy during normal physical activity. No bone loss was observed in the epiphysis, a site experiencing higher strain energy, despite a similar increase in bone turnover. The role of mechanical strain in maintaining bone balance was investigated by altering the strain history. Mechanical strain was increased or decreased in long bones of ovariectomized rats by treadmill exercise or functional unloading, respectively. Increasing mechanical loading reduced bone loss in the metaphysis. In contrast, decreasing weight bearing accentuated bone loss in the metaphysis and resulted in bone loss in the epiphysis. Finally, administration of estrogen to ovariectomized rats reduced bone loss in unloaded limbs and prevented bone loss in the loaded limbs. These results suggest that estrogen alters the mechanosensory (mechanostat) set point for skeletal adaptation, effectively reducing the minimum strain energy levels at which bone is added. Additionally, these studies suggest that physical activity as well as endocrine status play an important role in maintenance of the female skeleton during aging.
Lupus 1999
PMID:Mechanical signaling in the development of postmenopausal osteoporosis. 1045 19

We report an unusual case of pathologically proved femoral head Brodie's abscess mimicking avascular necrosis of bone in a 51-year-old woman with a 2-year history of corticosteroid treatment for systemic lupus erythematosus. On plain radiographs, a rounded lucency and thin sclerotic margins together with subchondral collapse and a lytic region were observed in the femoral head. The histopathologic examination revealed a central abscess formation surrounded by fibrous tissue with the aggregation of neutrophils and plasma cells. To our knowledge, this is the first case report describing a Brodie's abscess which had developed within the proximal femoral epiphysis in an adult.
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PMID:Brodie's abscess of the proximal femoral epiphysis in an adult woman with systemic lupus erythematosus. 1207 Jun 56

Disturbance of blood supply to the femoral head is a risk factor for corticosteroid-associated osteonecrosis. The aim was to measure blood supply of the proximal femur during corticosteroid therapy in systemic lupus erythematosus (SLE) patients. We repeatedly performed 78 dynamic MRIs of 19 hip joints in 19 SLE patients after initiation of corticosteroid administration for one year. Blood supply of the femoral head (epiphysis, growth plate, and metaphysis), the femoral neck, and the medial circumflex femoral artery were measured in terms of peak percent enhancement. At the first month, blood supply of the growth plate was significantly higher in the pediatric group (<15 years old) than in the adolescent and adult group (>15 years old). At the fourth month, blood supply in every part of the femoral head (epiphysis, growth plate, and metaphysis) was significantly higher in the pediatric group than in the adolescent and adult group. Multiple regression analysis revealed that blood supply to the femoral head depended on the number of days after initiation of corticosteroid administration and the age at the time of dynamic MRI. Blood supply to the femoral head is abundant in pediatric patients and is a function of the number of days after initiation of corticosteroid administration.
Lupus 2012 Mar
PMID:Recovery of the blood flow around the femoral head during early corticosteroid therapy: dynamic magnetic resonance imaging in systemic lupus erythematosus patients. 2202 Feb 68

We report the case of a 35-year-old male, who was diagnosed with systemic lupus erythematosus (SLE) in 2010 based on the presence of articular, serous, renal, immune, and hematologic involvement. He also had secondary antiphospholipid syndrome (APS). He was treated with prednisone 10 mg per day, hydroxychloroquine 200 mg per day, methotrexate 12.5 mg per week, leflunomide 20 mg per day, and oral anticoagulation previous to the present event. He presented to emergency room with a 7 day disease duration characterized by pain in the left thigh, which increased with physical activity, resulting in claudication; he also had malaise and fever. The X-ray films showed periostitis of the lower half of the left femur with bone marrow narrowing; the scintigraphy showed marked increased uptake in the middle and distal thirds of the left femur, and magnetic resonance imaging (MRI) showed thickening and hyperintensity of the cortex of the diaphysis and distal epiphysis of the femur and endosteal irregularity. Empirical treatment was started with vancomycin for 3 weeks. Femur biopsy and cultures were performed, isolating Salmonella spp. group "D" Vi (-); treatment with cotrimoxazole and ceftazidime for 4 weeks followed by doxycycline and cotrimoxazole for 4 months were given with a favorable functional outcome. This is an unusual case of a young adult with Garre's sclerosing osteomyelitis associated to SLE and caused by salmonella. The literature is reviewed and the clinical conditions predisposing to this infection are discussed, particularly in patients with SLE.
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PMID:Garre's sclerosing osteomyelitis caused by salmonella group D in a patient with systemic lupus erythematosus: an unusual complication. 2651 66