Advertisement

Rheumatology International

, Volume 39, Issue 1, pp 153–159 | Cite as

Clinical characteristics of avascular necrosis in patients with Behçet disease: a case series and literature review

  • Nuh AtasEmail author
  • Berivan Bitik
  • Ozkan Varan
  • Hakan Babaoglu
  • Abdurrahman Tufan
  • Seminur Haznedaroglu
  • Berna Goker
  • Mehmet Akif Ozturk
Cases with a Message
  • 80 Downloads

Abstract

Avascular necrosis (AVN), also known as osteonecrosis, is characterized by death of the osteocytes due to inadequate blood supply caused by various mechanisms. The hip is the most common affected joint followed by knee. Incidence of AVN in rheumatic diseases is variable and high corticosteroid (CS) therapy is a known major risk factor for development of AVN. Data on the AVN in Behçet disease (BD) are limited. The purpose of this study is to examine the clinical and treatment characteristics of BD patients with diagnosis of AVN. Retrospective medical records of 337 BD patients were reviewed. Nine BD patients with AVN were detected. The clinical data of these patients with AVN have been reviewed. All patients had MRI of the symptomatic joints compatible with AVN. All of the nine patients who were diagnosed with AVN were male. Median duration of BD was 7 years. Median time between diagnosis of BD and detection of AVN was 3 years (1–16 years). Multiple joints were involved in seven patients. Six patients had bilateral knee AVN. Six patients had vascular BD. The median time interval between initial CS dose and AVN development was 24 months (range = 2–100). The median highest daily CS dose was 64 mg/day (range = 32–80) and median cumulative CS dose prior to AVN was 18 g. All of patients had intravenous pulse steroids. CS treatment, smoking and vascular involvement may predispose to AVN in patients with BD. According to this cohort, AVN in BD frequently tended to be in the knee joint and bilateral.

Keywords

Behçet disease Avascular necrosis Corticosteroid Multifocal involvement 

Notes

Author contributions

In accordance with ICMJE criteria, NA designed the study and wrote the initial draft of the manuscript. AT contributed to the design of the study, the collection and interpretation of data, and the assistance of the preparation of the manuscript. All other authors contributed to the data collection and interpretation and revised the manuscript. The literature data were searched and analyzed by all authors. All authors approved the final version to be submitted for publication and agree to be accountable for all aspects of the work.

Funding

This paper has not been funded.

Compliance with ethical standards

Conflict of interest

Nuh Atas, Berivan Bitik, Ozkan Varan, Hakan Babaoglu, Abdurrahman Tufan, Seminur Haznedaroglu, Berna Goker and Mehmet Akif Ozturk declare that they have no conflicts of interest.

Ethical approval

Ethical approval was not required for this work because it contains retrospective data of patients and all treatment decisions were made prior to our evaluation.

Informed consent

Informed consent was obtained from all participants included in the study.

References

  1. 1.
    Mankin HJ (1992) Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med 326(22):1473–1479.  https://doi.org/10.1056/NEJM199205283262206 CrossRefGoogle Scholar
  2. 2.
    Moya-Angeler J, Gianakos AL, Villa JC, Ni A, Lane JM (2015) Current concepts on osteonecrosis of the femoral head. World J Orthop 6(8):590–601.  https://doi.org/10.5312/wjo.v6.i8.590 CrossRefGoogle Scholar
  3. 3.
    Hofmann S, Kramer J, Plenk H (2005) Osteonecrosis of the hip in adults. Orthopade 34(2):171–183.  https://doi.org/10.1007/s00132-005-0762-4 (quiz 184) CrossRefGoogle Scholar
  4. 4.
    Zhao DW, Yu M, Hu K, Wang W, Yang L, Wang BJ, Gao XH, Guo YM, Xu YQ, Wei YS, Tian SM, Yang F, Wang N, Huang SB, Xie H, Wei XW, Jiang HS, Zang YQ, Ai J, Chen YL, Lei GH, Li YJ, Tian G, Li ZS, Cao Y, Ma L (2015) Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the chinese population: results from a nationally representative survey. Chin Med J (Engl) 128(21):2843–2850.  https://doi.org/10.4103/0366-6999.168017 CrossRefGoogle Scholar
  5. 5.
    Mont MA, Glueck CJ, Pacheco IH, Wang P, Hungerford DS, Petri M (1997) Risk factors for osteonecrosis in systemic lupus erythematosus. J Rheumatol 24(4):654–662Google Scholar
  6. 6.
    Oinuma K, Harada Y, Nawata Y, Takabayashi K, Abe I, Kamikawa K, Moriya H (2001) Osteonecrosis in patients with systemic lupus erythematosus develops very early after starting high dose corticosteroid treatment. Ann Rheum Dis 60(12):1145–1148CrossRefGoogle Scholar
  7. 7.
    Sakamoto M (1994) A prospective study of steroid-induced osteonecrosis by MRI screening. Nihon Seikeigeka Gakkai Zasshi 68(5):367–378Google Scholar
  8. 8.
    Rajpura A, Wright AC, Board TN (2011) Medical management of osteonecrosis of the hip: a review. Hip Int 21(4):385–392.  https://doi.org/10.5301/HIP.2011.8538 CrossRefGoogle Scholar
  9. 9.
    Vreden SG, Hermus AR, van Liessum PA, Pieters GF, Smals AG, Kloppenborg PW (1991) Aseptic bone necrosis in patients on glucocorticoid replacement therapy. Neth J Med 39(3–4):153–157Google Scholar
  10. 10.
    Shigemura T, Nakamura J, Kishida S, Harada Y, Ohtori S, Kamikawa K, Ochiai N, Takahashi K (2011) Incidence of osteonecrosis associated with corticosteroid therapy among different underlying diseases: prospective MRI study. Rheumatology 50(11):2023–2028.  https://doi.org/10.1093/rheumatology/ker277 CrossRefGoogle Scholar
  11. 11.
    Tursen U, Gurler A, Boyvat A (2003) Evaluation of clinical findings according to sex in 2313 Turkish patients with Behcet’s disease. Int J Dermatol 42(5):346–351CrossRefGoogle Scholar
  12. 12.
    Hatemi G, Seyahi E, Fresko I, Talarico R, Hamuryudan V (2015) Behcet’s syndrome: a critical digest of the 2014–2015 literature. Clin Exp Rheumatol 33(6 Suppl 94):S3–S14Google Scholar
  13. 13.
    Lin YC, Liang TH, Chang HN, Lin JS, Lin HY (2008) Behçet disease associated with myelodysplastic syndrome. J Clin Rheumatol 14(3):169–174.  https://doi.org/10.1097/RHU.0b013e3181776bde CrossRefGoogle Scholar
  14. 14.
    Ersöz M, Ural G, Özdemir EE, Akkuş S (2013) Avascular necrosis of the femoral head in a patient with Behçet’s disease. Turk J Rheumatol 28(1):62–63.  https://doi.org/10.5606/tjr.2013.2758 CrossRefGoogle Scholar
  15. 15.
    Essaadouni L, Ha-ou-nou FZ (2017) Efficacy and safety of tocilizumab in neuro-Behçet’s disease: a case report. Revue Neurologique 173(3):171–172.  https://doi.org/10.1016/j.neurol.2017.02.006 CrossRefGoogle Scholar
  16. 16.
    Ronco P, Wechsler B, Saillant G, Godeau P (1981) Aseptic osteonecrosis during corticosteroid treatment of Behcet’s disease (author’s transl). Nouv Presse Med 10(21):1707–1710Google Scholar
  17. 17.
    Polat M, Bes C, Guven M, Cakar M, Soy M (2010) Steroid-induced bicondylar osteonecrosis of both femurs in a patient with Behcet’s disease. Clin Exp Rheumatol 28(4 Suppl 60):S95–S96Google Scholar
  18. 18.
    Chang HK, Choi YJ, Baek SK, Lee DH, Won KS (2001) Osteonecrosis and bone infarction in association with Behcet’s disease: report of two cases. Clin Exp Rheumatol 19(5 Suppl 24):S51–S54Google Scholar
  19. 19.
    Varoglu AO, Aksoy A (2017) Osteonecrosis in the both femoral heads in a patient with Neuro-Behcet’s Disease. Pak J Med Sci 33(3):770–772.  https://doi.org/10.12669/pjms.333.12815 Google Scholar
  20. 20.
    Criteria for diagnosis of Behcet’s disease (1990) International study group for Behcet’s disease. Lancet 335(8697):1078–1080Google Scholar
  21. 21.
    Vaiopoulos AG, Kapsimali V, Kanakis MA, Vaiopoulos G, Samarkos M, Zouboulis CC, Kaklamanis PG (2018) The frequency of arthritis in Adamantiades–Behcet’s disease in Greek patients. J Eur Acad Dermatol Venereol.  https://doi.org/10.1111/jdv.15326 Google Scholar
  22. 22.
    Horton DB, Haynes K, Denburg MR, Thacker MM, Rose CD, Putt ME, Leonard MB, Strom BL (2017) Oral glucocorticoid use and osteonecrosis in children and adults with chronic inflammatory diseases: a population-based cohort study. BMJ Open 7(7):e016788.  https://doi.org/10.1136/bmjopen-2017-016788 CrossRefGoogle Scholar
  23. 23.
    Abeles M, Urman JD, Rothfield NF (1978) Aseptic necrosis of bone in systemic lupus erythematosus. Relationship to corticosteroid therapy. Arch Intern Med 138(5):750–754CrossRefGoogle Scholar
  24. 24.
    Mok CC, Lau CS, Wong RW (1998) Risk factors for avascular bone necrosis in systemic lupus erythematosus. Br J Rheumatol 37(8):895–900CrossRefGoogle Scholar
  25. 25.
    Matsuo K, Hirohata T, Sugioka Y, Ikeda M, Fukuda A (1988) Influence of alcohol intake, cigarette smoking, and occupational status on idiopathic osteonecrosis of the femoral head. Clin Orthop Relat Res 234:115–123Google Scholar
  26. 26.
    Calvo-Alen J, McGwin G, Toloza S, Fernandez M, Roseman JM, Bastian HM, Cepeda EJ, Gonzalez EB, Baethge BA, Fessler BJ, Vila LM, Reveille JD, Alarcon GS, Group LS (2006) Systemic lupus erythematosus in a multiethnic US cohort (LUMINA): XXIV. Cytotoxic treatment is an additional risk factor for the development of symptomatic osteonecrosis in lupus patients: results of a nested matched case-control study. Ann Rheum Dis 65(6):785–790.  https://doi.org/10.1136/ard.2005.040428 CrossRefGoogle Scholar
  27. 27.
    Kural-Seyahi E, Fresko I, Seyahi N, Ozyazgan Y, Mat C, Hamuryudan V, Yurdakul S, Yazici H (2003) The long-term mortality and morbidity of Behcet syndrome: a 2-decade outcome survey of 387 patients followed at a dedicated center. Medicine (Baltimore) 82(1):60–76CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Rheumatology, Department of Internal MedicineGazi University Faculty of MedicineAnkaraTurkey
  2. 2.Division of Rheumatology, Department of Internal MedicineBaskent University Faculty of MedicineAnkaraTurkey

Personalised recommendations