Osteonecrosis in systemic lupus erythematosus: Systematic insight from the epidemiology, pathogenesis, diagnosis and management.

Abstract Osteonecrosis (ON) is a one of the serious and well recognized complication causing severe pain and disability in patients with systemic lupus erythematosus (SLE) while its manifestation and pathogenesis is only partially understood. This review provides an update of the recent progress in etiology, pathogenesis, diagnosis, and treatment of systemic lupus erythematosus related osteonecrosis (SLE-ON). Despite of the concomitant use of corticosteroids, alcohol and obesity, the dysregulated immune micro-environment and complex pathogenesis of SLE play important roles in the development of ON. Osteonecrosis of femoral head (ONFH) is the most involvement joint in SLE. Present classification and staging system of ONFH is based on imaging techniques, particularly relating to MRI and CT, for the identification and quantification of necrotic lesions. For SLE-ONFH patients, both SLE specific clinical symptoms and ONFH imaging findings should be comprehensively evaluated. Although advances concerning bone grafting and arthroplasty procedures have resulted in improved clinical outcome, early pharmacological treatment at precollapse stage may prevent the joint collapse and reduce joint arthroplasty rate, and need to be accounted. Although some progress has been made, considerably more research is needed before we fully understand SLE-ONFH. The future treatment of SLE-ONFH may involve genetic or cell-based therapies targeting potential biomarkers, and will lead to effective measures for saving the femoral head and preventing osteonecrosis.