Osteonecrosis of the distal tibia in systemic lupus erythematosus: A rare case report.

Abstract Introduction Osteonecrosis (ON) is characterized by cellular death of bone components due to interruption of blood supply that leads to bone ischemia and potential joint destruction. There are multiple risk factors and medical condition associated with ON, including systemic lupus erythematosus (SLE). The most common sites of ON are the femoral head, distal femur, proximal humerus, talus and lumbar spine. Very few cases of nontraumatic ON in distal tibia have been reported in the literature. Case Illustration We present a case of 23-year-old female diagnosed with osteonecrosis of distal tibia and history of SLE. The patient also had history of avascular necrosis of right hip and underwent right total hip arthroplasty. We treated the patients with conservative treatment for intial management. Discussion The risk of ON in SLE patients is likely the result of both the SLE disease state itself and the use of corticosteroids as medication. Systemic inflammation in SLE reduces the development of osteoblasts, increases osteoclast maturation and activity and increases protohrombotic agents that can lead to rapid bone loss. CS are the the most consistent factor associated with the development of ON in SLE. Conservative medical management is effective in the early stages of the disease before bone collapse. Conclusion Despite advancements in the diagnosis and treatment of SLE, symptomatic osteonecrosis continues to be a significant comorbidity. Strategies to detect and manage early stages of ON is necessary to prevent progression of this serious complication.