Ischemic bone necrosis in systemic lupus erythematosus. II. The early diagnosis of ischemic necrosis of bone.

It would appear from our experience thus far, that increased bone marrow pressure and altered venous drainage, as documented by venography, are present in all stages of ischemic necrosis of bone, including the pre-radiologic, and may be the earliest detectable changes in this disorder. This implies that any postulated pathogenetic mechanism must take into account the early appearance of significant venous derangement, although not necessarily indicating that the venous abnormalities are primary. The data indicate that the venous circulation participates in and undoubtedly contributes to the progression of the disorder. In addition the successful results of core decompression reported in Part II, lend support to such a pathogenetic sequence, and may well be due to the interruption of this vicious circle.