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AVN Prevalence SLE — SCE Rheumatology MCQ

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HardSLE & Antiphospholipid SyndromeAVN Prevalence SLESCE Rheumatology

A patient taking long-term glucocorticoids has severe hip pain but normal plain radiographs. Avascular necrosis remains suspected. What is the best next test?

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Correct answer: B — Bilateral hip MRI for radiographically occult osteonecrosis

MRI is the most sensitive test for early osteonecrosis when radiographs are normal and should include both hips because disease may be bilateral. Early diagnosis informs weight-bearing advice and joint-preserving or replacement referral.

Reference: Royal National Orthopaedic Hospital guide to avascular necrosis (Current NHS specialist guide, accessed 30 July 2026): https://www.rnoh.nhs.uk/patients-and-visitors/patient-information-guides/patients-guide-avascular-necrosis-avn; Guideline for diagnosis and treatment of adult femoral-head osteonecrosis (Published 2019): https://pmc.ncbi.nlm.nih.gov/articles/PMC6583727/