Early diagnosis and preventive strategy of corticosteroid induced osteonecrosis in systemic autoimmune diseases

Osteonecrosis of femoral head (ONF) is one of the serious adverse events in the patients with systemic lupus erythematosus (SLE) associated with corticosteroid therapy. We have reported a multicenter prospective study of prevention of ONF in SLE patients on high doses of corticosteroids using anticoagulant of warfarin. In the diagnosis of ONF, plain radiography and magnetic resonance imaging (MRI) are important. Especially, in early stage of ONF, although the plain radiograph is still normal, evident changes can be seen in MRI. The treatment of ONFremains controversial. Anticoagulants may be useful to prevent ONF. Therefore, early diagnosis and prevention of ONF are critical issues especially in SLE patients. In this chapter, we present the radiological images illustrating osteonecrosis in patients with autoimmune diseases including SLE, and review the strategy to prevent ONF induced by corticosteroids.