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Glucocorticoid AVN Lupus — ESENeph MCQ

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ModerateGlomerulonephritisGlucocorticoid AVN LupusESENeph

A 40-year-old man with SLE and Class IV lupus nephritis on induction therapy develops avascular necrosis (AVN) of the femoral head. He has been on Prednisolone 40 mg daily for 3 months. What is the association?

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Correct answer: A — High-dose glucocorticoids are the most important risk factor for AVN – fat cell hypertrophy and microthrombi in subchondral vessels lead to bone ischaemia; the femoral head is most commonly affected

Avascular necrosis (osteonecrosis) is a well-recognised complication of high-dose glucocorticoid therapy. The mechanism involves glucocorticoid-induced fat cell hypertrophy in bone marrow (increasing intraosseous pressure), microvascular thrombosis, and impaired osteoblast function, leading to ischaemic bone necrosis. The femoral head is the most common site due to its tenuous blood supply. Risk increases with cumulative dose and duration. MRI is the most sensitive diagnostic modality. This complication underscores the importance of minimising steroid exposure in LN – KDIGO 2024 recommends steroid-sparing regimens.

Reference: KDIGO 2024 – Lupus Nephritis; Weinstein 2012 – Glucocorticoid-Induced Osteonecrosis