Lupus and AVN

Question

I am 48yo, hispanic decent woman diagnosed with SLE 8 years ago. Recently, my left shoulder has dropped and more painful than previous. Ortho doctor has suggested I have a “frozen shoulder”, but more probably AVN. I cannot have an MRI for diagnosis because of spinal fusion appliances. I understand there is a connection between Lupus and AVN. What is AVN? He recommended complete shoulder replacement, but because of constant flairs of Lupus, (pleurisy and kidney) I have waited nearly one year. Currently, on NO meds for lupus because I have reacted to everything (Celebrex, Vioxx cause my kidney’s to bleed) Plaquenil had no effect (on for 2 1/2 years) low dose steroids cause an allegic reaction. I currently take dilaudid for pain management, but it is not helping. I do not have a rheumatologist – doctors in my area (Florida) are not taking new Medicare patients. I am stuck. Any information you can give me would be appreciated. I would love to come to MD, but can not afford the trip, and the nearest teaching hospital to me is Gainesville (a 5 hour trip I can not make because of discomfort).

Answer

Avascular necrosis (AVN) is also known as osteonecrosis is a condition in which the bone does not get enough blood supply and dies. It is most commonly seen in the hip after a fracture which disrupts blood supply to the head of the femur. AVN is most common in large joints– hips, knees and shoulders. Use of high dose prednisone is a risk factor for AVN, particularly in SLE patients. Alcohol use, sickle cell anemia and HIV are also risk factors. Some SLE patients have increased blood clots due to abnormal antibodies and this should be looked at as well. You need to see a rheumatologist or a smart internist to help with the work-up.

Once AVN starts and the x-rays show damage, the joints often progressively become destroyed to the point where they need replacement. Early diagnosis before x-ray damage is done with MRI or bone scan. Dr. Michael Mont at Sinai Hosp in Baltimore is the local orthopedic expert.

Alan Matsumoto, M.D.

About Alan Matsumoto, M.D.

Part-time Faculty, Division of Rheumatology
Johns Hopkins University