Aranow C, Zelicof S, Leslie D, Solomon S, Barland P, Norman A, Klein R, Weinstein A
Department of Medicine, New York Medical College, Valhalla, USA.
J Rheumatol. 1997 Dec;24(12):2318-22.
To study the natural history of clinically occult avascular necrosis (AVN) of the hip in patients with systemic lupus erythematosus (SLE).
Sixty-six patients with SLE (without symptoms referable to the hip) receiving at least 5 mg/day prednisone for > or = 6 months were screened by magnetic resonance imaging (MRI) for AVN of the hip. A complete MRI evaluating class and percentage of femoral head involvement, AP and lateral radiographs of the hips, bone scan, and physical examination were performed for patients with positive MRI. Medical records were reviewed for serologic and clinical variables that might predict AVN. Repeat MRI were obtained at 3, 6, and 12 months to assess possible progression or resolution of the lesion. Patients with negative screening MRI underwent repeat screening after one year to assess the one year incidence rate.
Eleven asymptomatic hips (8%) in 8 patients (12%) had MRI documented AVN. The percentage of femoral head involvement ranged from 1 to 46%. One lesion was MRI class B, the remaining lesions were class A. The radiographic stage of 10 hips was stage 1, the MRI class B hip was stage 2. Risk factors for clinically occult AVN included Afro-American origin, Raynaud's phenomenon, migraine headaches, and a maximal corticosteroid dose of at least 30 mg/day. After 12 months, 43 of 58 patients with an initially negative MRI underwent repeat screening examinations; no new lesions were observed.
Clinically occult AVN of the hip is common in patients with SLE. The short term natural history of these lesions appears stable without spontaneous healing or clinical or radiographic progression. Risk factors for these asymptomatic lesions are similar to the risks for symptomatic AVN and surgical intervention appears not to be indicated in these patients.
研究系统性红斑狼疮（SLE）患者髋关节临床隐匿性缺血性坏死（AVN）的自然病程。
对66例接受至少5mg/天泼尼松治疗≥6个月且无髋关节相关症状的SLE患者进行髋关节AVN的磁共振成像（MRI）筛查。对MRI检查阳性的患者进行全面的MRI检查以评估股骨头受累的分级和百分比，同时拍摄髋关节前后位和侧位X线片、骨扫描以及进行体格检查。查阅病历以了解可能预测AVN的血清学和临床变量。在3个月、6个月和12个月时重复进行MRI检查以评估病变可能的进展或缓解情况。MRI筛查阴性的患者在1年后进行重复筛查以评估1年发病率。
8例患者（12%）的11个无症状髋关节（8%）经MRI证实存在AVN。股骨头受累百分比范围为1%至46%。1个病变为MRI B级，其余病变为A级。10个髋关节的X线分期为1期，MRI B级髋关节为2期。临床隐匿性AVN的危险因素包括非裔美国人血统、雷诺现象、偏头痛以及最大皮质类固醇剂量至少为30mg/天。12个月后，58例最初MRI检查阴性的患者中有43例接受了重复筛查检查；未观察到新的病变。
SLE患者中髋关节临床隐匿性AVN较为常见。这些病变的短期自然病程似乎稳定，无自发愈合或临床及影像学进展。这些无症状病变的危险因素与有症状AVN的危险因素相似，这些患者似乎无需手术干预。
