The objective of this study was to define prospectively the early development of
corticosteroid-induced
osteonecrosis of femoral head (ONF) in patients with
systemic lupus erythematosus (SLE) and to identify the association of initial
steroid treatment with the development of early (silent) ONE Forty-five patients who were newly diagnosed as having SLE and required 40 mg/day or more
prednisolone were enrolled. To detect silent ONF, examinations using magnetic resonance imaging (MRI) were done three months after starting
steroid therapy, followed by every year's MRI and plain radiography for over five years. Clinical and laboratory data were compared between silent ONF and non-ONF groups. Of 45 patients, 15 (33%) developed silent ONF and five (11%) symptomatic ONE It was of interest that MRI detected silent ONF very early (by three months) in 14 patients (93%). It should be noted that pulse
therapy with 1000 mg/day
methylprednisolone was found to be done very frequently (13 of 15, 87%) in the silent ONF group compared to non-ONF group (11 of 30, 37%) (P < 0.01) although other clinical features were not significantly different between both groups. High dose
corticosteroids caused elevation of serum levels of total
cholesterol,
albumin, and leukocyte count in most of patients. The degree of elevation of those parameters at one or three months was more prominent in the silent ONF group. In particular, the change ratio of total
cholesterol at one month was outstanding in the silent ONF group compared to non-ONF group (0.551 versus 0.374, P < 0.05). In conclusion, pathological ONF develops very early in one-third of SLE patients who received high dose
corticosteroids and
steroid pulse
therapy could be a significant risk factor. An abrupt elevation of serum total
cholesterol and/or sensitivity to
steroids seem to be associated with the pathogenesis of ONF.