Avascular Necrosis of Bone complicating Steroid Therapy

Abstract

The effects of steroids on the skeleton have been described extensively, and it is not surprising that most of the information regarding joint changes in this context has been obtained from the study of the effects of steroids on rheumatoid disease or osteoarthritis. In these conditions it is of some interest that cortisone and its analogues may sometimes appear to hasten a destructive process, especially in weight-bearing joints such as the hip (Ansell, 1958; Chandler and Wright, 1958; Chandler, Jones, Wright and Hartfall, 1959; Murray, 1960; 1961; Sweetnam, 1960). It is felt that this type of joint lesion must be distinguished clearly from avascular necrosis of bone occurring in association with steroid therapy in patients without evidence of previous arthropathy. Prior to 1963 few examples of such a condition were recorded. Four cases were described by Heimann and Freiberger (1960), two of their patients showing changes in both the femoral and humeral heads. One case, also with hips and shoulders affected, was recorded by Meyer, Goiter and Hawley (1963). These five patients were treated for conditions other than rheumatoid disease or osteo-arthritis, namely thrombocytopenic purpura (two cases), erythema multiforme bullosum, chronic pemphigus, and multiple sclerosis. More recently (1964) d'Aubigné reviewed 104 cases of avascular necrosis of the hips in adults, observing that in 36 per cent of the cases steroids had been given “before the pain appeared in the hip, and for another condition”.