Prevalence of avascular necrosis in idiopathic inflammatory myopathies: a single-centre experience. (27th June 2021)

• Record Type: Journal Article
• Authors: Bourji, Khalil I; Mecoli, Christopher A; Paik, Julie J; Albayda, Jemima; Tiniakou, Eleni; Kelly, William; Lloyd, Thomas E; Mammen, Andrew; Ahlawat, Shivani; Christopher-Stine, Lisa
• Is Part Of: Rheumatology. Volume 61:Number 3(2022)
• Page Start: 936
• Page End: 942
• Publication Date: 2021-06-27
• Subjects: avascular necrosis -- osteonecrosis -- AVN -- myositis; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keab493
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objectives: To assess the prevalence of avascular necrosis (AVN) in a large cohort of patients with idiopathic inflammatory myopathies (IIM) and define the major associated risk factors. Methods: We retrospectively reviewed the electronic medical records of all patients with a definitive diagnosis of IIM enrolled in our registry between 2003 and 2017, and followed until 2020. Pertinent demographic, clinical, serologic and imaging data were collected. A matched group of patients without AVN was then selected for comparison. Results: A total of 1680 patients were diagnosed with IIM. Fifty-one patients developed AVN, with an overall prevalence of 3%. Musculoskeletal MRI was available for 1085 patients and AVN was present in 46 patients (43 lower extremities and 3 upper extremities MRI studies), with a relative prevalence of 4.2%. Most patients with AVN were Caucasian females (57%) with a mean (s .d .) age at diagnosis of 44.5 (12.4) years. Sixty-one percent had DM and 29% had PM. The median time from onset of IIM to diagnosis of AVN was 46 months. The hip joint was most commonly involved in 76% of cases, followed by the knee joint in 15% and shoulder joint in 9%. Some 81% of patients were asymptomatic. Established risk factors for AVN were not found to be associated with the development of AVN in IIM patients. Conclusion: Although mostly asymptomatic and incidental, the overall prevalence of AVN in IIM was 3% and the prevalence by MRI was 4.2%. None of the established risk factors was found to be associated with AVN development.