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AVN Prevalence SLE — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeAVN Prevalence SLESCE Rheumatology

A 48-year-old woman with systemic lupus erythematosus, previously exposed to prolonged prednisolone treatment, develops osteonecrosis affecting both humeral heads and both knees. Which statement best reflects pooled evidence on the prevalence and anatomical distribution of osteonecrosis in SLE?

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Correct answer: B — Symptomatic osteonecrosis occurs in about 9%, asymptomatic MRI-detected disease in about 29%, and the femoral head is the most common site.

A meta-analysis found a pooled prevalence of approximately 9% for symptomatic osteonecrosis in SLE, although individual studies varied substantially. MRI screening identifies asymptomatic disease more frequently, with a pooled prevalence of about 29%. The femoral head is the commonest anatomical site. Hips and knees predominate in large clinical cohorts, and multifocal involvement is common, so this patient's humeral and knee disease is compatible with SLE-associated osteonecrosis. Glucocorticoid exposure, particularly high-dose exposure, is an important risk factor. The other options substantially under- or overestimate prevalence, reverse the symptomatic and asymptomatic estimates, or incorrectly identify the humeral head, knee, spine or talus as the commonest site.

Reference: Nevskaya T, Gamble MP, Pope JE. A meta-analysis of avascular necrosis in systemic lupus erythematosus: prevalence and risk factors. Clinical and Experimental Rheumatology. 2017;35:700–710. https://pubmed.ncbi.nlm.nih.gov/28240590/