study of avascular necrosis [osteonecrosis] in systemic lupus erythematosus patients and its relation to corticosteroid therapy

Avascular necrosis [AVN] of the femoral head has been reported to be one of the major problems during the course of SLE. In a retrospective study of 30 patients with SLE, four [13.3%] were found to have AVN all had been on corticosteroids. Of these, three [75%] had Raynaud's phenomenon, three [75%] took pulse steroid therapy, and three [75%] had thrombocytopenia. None of the patients abused alcohol or had chronic liver disease. A positive correlation was found between hyperelipidaemia as well as the presence of high titre of anticardiolipin antibodies [both IgMand IgG] and the occurence of AVN. Moreover, statistically significant differences were found between patients with and without AVN as regards the total duration of steroid intake, the total cumulative prednisolone dose or its equivalent as well as the daily dose with significantly higher levels in patients with AVN than in those without. So, it is suggested that corticosteroid therapy play the major role in the development of AVN in SLE patients in addition to lipid and haemostatic abnormalities

role of von-wellbrand's factor; fibronectin and lipid profile as risk factors for vascular damage in rheumatoid arthritis and systemic sclerosis

This study was designed to determine the roles of Von-Willbrand's factor, fibronectin and lipid profile as risk factors in etiopathogensis of vascular lesions in 20 rheumatoid disease patients [RD] diagnosed according to American Rheumatism Association Criteria and 20 Systemic Sclerosis patients [SSc] diagnosed according to the preliminary criteria for SSc. 20 healthy subjects of matched age and sex were included as control group. Variable degrees of vascular lesions were detected: Raynouds phenomenon [RD 30%, SSc 50%] cutaneous telangiectasia and digital ulcers [RD 5%, SSc 40%], peripheral vascular insufficiency via Doppler study [RD 5%, SSc 40%], clinically evident systemic hypertension [SSc 15%], pulmonary vascular disease via Echo-Doppler study [RD 5%, SSc 20%], Coronary heart disease via E.C.G and Echo-Doppler study [20% in RD, 15% in SSc] and clinically evident cerebrovascular strokes [RD 10% SSc 10%]. The mean plasma levels of Von-Willebrand's factor and fibronectin were significantly higher in RD and SSc patients than in controls and the highest levels were observed in patients with vascular manifestations particularly with SSc., suggesting the presence of endothelial dysfunction and were considered as non invasive markers of vascular damage which are more prominant in SSc than in RD. The total serum lipids, Triglycerides, cholesterol, LDL-cholesterol, free fatty acids and Apoprotein B-were, significantly increased while HDL-cholesterol and apoprotein A, were significantly decreased, suggesting the presence of atherogenic dyslipidemic pattern in the etiopathogenesis of vascular manifestations in RD and SSc. The higher levels which observed in RD patients with vascular manifestations are most probably due to patients inactivity resulting from articular lesions or due to steroid therapy induced dyslipedemia. Circulating levels of endothelial cell products such as VWF and fibronectin may reflect the role of the immune mechanism in the pathogenesis of RD and SSc vascular disease and assist the clinician in monitoring response to therapy. Furthermore, monitoring of VWF and fibronectin as parameters of endothelial cell injury may help to define the vascular disease in an early and more measuringful fashion