A CASE OF AVASCULAR NECROSIS OF THE BILATERAL CAPUT FEMORAL IN FEMALE PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Femi Syahriani; Muhammad Andry Usman; Nur Fatma

doi:10.24252/alami.v7i1.35924

Femi Syahriani
(ID)
Muhammad Andry Usman Departemen Bedah Ortopedi Fakultas Kedokteran Universitas Hasanuddim/RS Wahidin Sudirohusodo/RS UNHAS/RS Siloam Makassar
(ID)
Nur Fatma Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Hasanuddin Makassar
(ID)

DOI: https://doi.org/10.24252/alami.v7i1.35924

Kata Kunci: Nekrosis avaskular, Sistemik Lupus Eritematosus, Glukokortikoid

Abstrak

Nekrosis avaskular (osteonekrosis, nekrosis aseptik, atau nekrosis iskemik) keadaan patologi yang disebabkan oleh berbagai etiologi yang menyebabkan penurunan suplai vaskuler sehingga mengakibatkan iskemik tulang. Nekrosis avaskular meningkatkan morbiditas pada pasien systemic lupus erythematosus (SLE). Beberapa faktor yang berkontribusi yaitu suplai vaskular pada tulang, penggunaan kortikosteroid, vaskulitis, siklofosfamid dan SLE sendiri merupakan faktor risiko nekrosis avaskular. Dilaporkan kasus perempuan berusia 20 tahun datang ke rumah sakit dengan keluhan nyeri pada kedua pinggul menyebabkan pasien kesulitan dalam berjalan dan aktivitas fisik sehari-hari. Pasien didiagnosis SLE sejak tahun 2017 dan salah satu terapi yang dikonsumsi adalah glukokortikoid selain obat DMARD (Disease Modifiying Atritis Reumatoid Drugs). Pemeriksaan fisis didapatkan keterbatasan Range of Movement (ROM) baik fleksi maupun ekstensi pada hip join bilateral. Radiografi Hip Joint Bilateral didapatkan gambaran avaskular nekrotik kaput femoris bilateral. Selanjutnya dilakukan total hip replacement dan mengalami perbaikan.

Referensi

Basyal B, Bhandari B, Derk CT. Avascular necrosis in systemic sclerosis patients: a case-based review of demographics, presentation, and management. Clin Rheumatol. 2021;40(1):399–405.

Nevskaya T, Gamble MP, Pope JE. A meta-analysis of avascular necrosis in systemic lupus erythematosus: prevalence and risk factors. Clin Exp Rheumatol. 2017;35:700–10.

Abu-shakra M, Buskila D, Shoenfeld Y. Osteonecrosis in Patients with SLE. 2003.

Adikari M, Gunawardane A, Illangantilaka S, Atukorale H, Rubasinghe J. A case of systemic lupus erythematosus presenting as bilateral avascular necrosis of femur. BMC Res Notes. 2016;9(1):1–3.

Mok MY, Farewell VT, Isenberg DA. Risk factors for avascular necrosis of bone in patients with systemic lupus erythematosus: Is there a role for antiphospholipid antibodies? Ann Rheum Dis. 2000;59(6):462–7.

Kwon HH, Bang SY, Won S, Park Y, Yi JH, Joo YB, et al. Synergistic effect of cumulative corticosteroid dose and immunosuppressants on avascular necrosis in patients with systemic lupus erythematosus. Lupus. 2018 Sep 1;27(10):1644–51.

Dogan İ, Kalyoncu U, Kiliç L, Akdoğan A, Karadağ Ö, Kiraz S, et al. Avascular necrosis less frequently found in systemic lupus erythematosus patients with the use of alternate day corticosteroid. Turk J Med Sci. 2020;50(1):219–24.

Kaneko K, Chen H, Kaufman M, Sverdlov I, Stein EM, Park‐Min K. Glucocorticoid‐induced osteonecrosis in systemic lupus erythematosus patients. Clin Transl Med. 2021 Oct;11(10).

Rella V, Rotondo C, Altomare A, Cantatore FP, Corrado A. Bone Involvement in Systemic Lupus Erythematosus. Vol. 23, International Journal of Molecular Sciences. MDPI; 2022.

Faezi ST, Hoseinian AS, Paragomi P, Akbarian M, Esfahanian F, Gharibdoost F, et al. Non-corticosteroid risk factors of symptomatic avascular necrosis of bone in systemic lupus erythematosus: A retrospective case-control study. Mod Rheumatol. 2015;25(4):590–4.

Shaharir SS, Chua SH, Mohd R, Mustafar R, Noh MM, Shahril NS, et al. Risk factors for symptomatic Avascular Necrosis (AVN) in a multi-ethnic Systemic Lupus Erythematosus (SLE) cohort. PLoS One. 2021 Mar 1;16(3 March).

Tsai HL, Chang JW, Lu JH, Liu CS. Epidemiology and risk factors associated with avascular necrosis in patients with autoimmune diseases: a nationwide study. Korean Journal of Internal Medicine. 2022;37(4):864–76.

Hussein S, Suitner M, Béland-Bonenfant S, Baril-Dionne A, Vandermeer B, Santesso N, et al. Monitoring of osteonecrosis in systemic lupus erythematosus: A systematic review and metaanalysis. Vol. 45, Journal of Rheumatology. Journal of Rheumatology; 2018. p. 1462–76.

Caramaschi P, Biasi D, Dal Forno I, Adami S. Osteonecrosis in systemic lupus erythematosus: An early, frequent, and not always symptomatic complication. Vol. 1, Autoimmune Diseases. 2012.

Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: Pathophysiology and current concepts of treatment. EFORT Open Rev. 2019 Mar 1;4(3):85–97.

Takashima K, Sakai T, Hamada H, Takao M, Sugano N. Which classification system is most useful for classifying osteonecrosis of the femoral head? Clin Orthop Relat Res. 2018 Jun 1;476(6):1240–9.