Tag Archive | aching joints and lupus and steroids

The Stages of Osteonecrosis

April 06, 2013

A post about stages of osteonecrosis (a complication of lupus), needs an introductory explanation of WHAT osteonecrosis-or avascular necrosis-is. Basically, osteonecrosis is the condition that results when the blood supply to bones is cut off, often by a tiny blood clot caused by lupus. Lupus can cause tiny blood clots to  form, and therefore, this is a complication of this autoimmune disease.


“Stages of Osteonecrosis (Avascular Necrosis)

Osteonecrosis (Avascular Necrosis) is classified in stages referring to how far the disease has progressed. There are the Ficat and the Steinberg Classification systems. Most orthopedic doctors use the Ficat classification system to determine at what stage your disease is. The stages are as follows:

Stage I: 

  • X-Ray: ON (AVN) is not detectable.
  • MRI: there might appear slight bone marrow edema or joint effusion. Joint effusion most commonly appears in the knees.
  • Bone Scan: evidence of increased uptake. Increased uptake is mainly due to increased activity of osteoblasts (cells responsible for bone formation) associated with new bone formation, and to a lesser degree by increased blood flow to bone. Increased uptake is an indication that there might be a tumor, fracture or infection.

Stage II:

  • X-Ray: mixed osteopenia, a condition where bone mineral density is lower than normal, or evidence of sclerosis.
  • MRI: evidence of lesion; an abnormality in bone tissue.
  • Bone Scan: increased uptake (see note above).

Stage III:

  • X-ray & MRI: bone collapse of joint appears imminent.

Stage IV:

  • X-ray & MRI: collapse of joint.
Image taken from the Journal of the American Academy of Orthopaedic Surgeons

To learn more click here: Ficat Classification and Steinberg Classification

A lot of websites, talking about Ficat Classification, refer to the level of pain at each stage of the disease. One indication of early ON (AVN) in the hips is pain in the groin. However, it appears to me that the pain differs from one ON (AVN) sufferer to another. My ON (AVN) is in my distal femurs and the first time I felt pain was in my knee caps.  As the disease worsened the pain ran like hot rods up and down my thighs.Take into account that every body is different.”

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Steroids for lupus

Does the sheer act of getting out of bed hurt so much that staying under the covers in your warm cocoon seem like a good plan? Does the thought of stirring your stumps petrify you? But, that’s just what your joints may need. A little ‘3-in-1- oil!’

Your doctor offered a solution: water (pool) therapy and a short course of steroids. While giving his proposal of steroids some thought this eve, you turned on the news and had an ‘aha’ moment! Steroids are what athletes use to body-build. Are you looking for 6 pack abs, bulging muscles and huge shoulders? Since your answer is a resounding ‘no,’ you explain to the doc ‘no thanks.’ That is, until he explains a few things about steroids.

But, not all steroids make you ‘run your fastest, jump your highest’ so that you can play in the big leagues! That’s only true of some type of steroids; there are three MAIN categories, and each category includes many steroid medications.

The first category we’ll mention is the anabolic steroid. They DO build muscle mass and are used by athletes sometimes to enhance performance. Several of these medications are either discouraged or are illegal. Usually these are the steroids that are in the news.

The second class of steroids is the androgenic steroid; testosterone is in this class. It, too can build muscle mass and give masculine features.

The third class are the Corticosteroids, the medications which we’ll refer to from now on when we mention steroids. These are the steroids your doctor will order; there’s no guarantee that steroids will be effective, but a decision must be made soon.

The last class of of corticosteroiods, include Cortisone,TM Decadron,TM BetamethasoneTM and HydrocortisoneTM . Those are the steroids our doctors may prescribe for lupus symptoms or to treat other causes of inflammation when over the counter non-steroidal medications (such as ibuprofen and naproxyn) aren’t effective.   Steroids are present in cell membrane to make them more stable. They are life-savers in asthma. But, why are they, these medications that can build muscle mass, used in the treatment of lupus?

The main reason that steroids are used in lupus is for their anti-inflammatory benefits. Lupus is a disease which causes massive inflammation in various parts of the body;  So, if  inflammation is causing symptoms, as in asthma (effectively narrowing the airways)  , a steroid might be indicated to decrease the inflammation which is narrowing the airways, making breathing normal again. This is a case where steroids can save lives.

Another use of steroids in lupus is in pleurisy, inflammation of the lung. The lowest dose that is will relieve symptoms and is necessary for treatment should be prescribed because of side effects of steroids. Steroids can have very good effects, but some very bad side effects; which include (in no specific order):

  1. interference with fat metabolism and forming clots which can cause heart disease and stroke .
  2. increase in weight
  3. increase in blood pressure
  4. agressive personality
  5. delusions
  6. psychosis
  7. osteonecrosis when steroids effect changes in fat metabolism that are such that the body ‘lays down’ fatty clots which can lead to bone death (osteonecrosis)

These isn’t an all-inclusive list of steoid side effects. Unfortunately, some of these side effects are permanent. For example, steroids are often given for asthmatic attacks because they can halt an asthma attack in it’s track, by decreasing inflammation of the bronchial ‘tubes.’  But, they can also have quite a damaging effect on the bones. So, a treatment decision may be, ‘To breathe and take your chances about developing bone disesase or not breathe.’ Quite an untenable position.

So, when steroids are good, they’re very very good; but when they’re bad, they’re horrid!

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