Prednisone use related to bone contusions

[Mbherr]

I am a 52 y/o w/f diagnosed with undifferentiated autoimmune disease dating back to approx. 1995 when I developed an array of symptoms. During an exacerbation of symptoms in fall of 2004 I was put on oral prednisone 30 - 40 mgs daily over about a 9 month period of time, gradually tapering down until I was completely off the prednisone.  I took the prednisone starting around November of 2004 and was tapered off around June of 2005. In January of this year (2007) I developed severe right knee pain.  An MRI showed contusion type areas in the head of tibia and bottom of the femur, although I have no injury associated with the right knee or this area.  Subsequent MRI of the left knee/leg is showing the same type of contusions, although not as extensive as the right, again without any injury history.  I do have patella problems in both knees, but this seems to be unrelated to the contusions showing up.  Necrosis of the bone has been ruled out.  The physician says that something has caused a decreased blood supply at some time and that there is swelling and inflammation of the bone, most likely caused by autoimmune disease and/or prednisone use.  I have not been on prednisone since 2005. Since I am no longer on prednisone, is this a continued manisfestation of the undifferentiated autoimmne disease and can this be damage showing up this late just now from the prednisone usage?   My physician indicates a knee replacement will manage the problem once I get more stabalized with this exacerbation of knee symptoms.  I did 6 weeks of limited weight bearing on the right knee, thus causing the left knee to flare up.  I also take plaquinil and just started azathioprine because of this recent development.     Any information is appreciated to help me understand this new deveplement. THank you.  Mbherr

[Kevin Pho, MD]

It will be difficult to say what the exact cause is over the internet.  

Either possibility, be it the steroids or the autoimmune disease, can be considered.  Avascular necrosis is not an uncommon effect of both steroids and autimmune disease like lupus.  The typical dose of chronic steroids that lends itself to this risk is greater than 20mg per day.

Joint replacement, osteotomy, or the use of bisphsophonates (i.e. Fosamax) have all been shown to be possibly beneficial in these cases.  

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[Dafe]

I'm not a physician but I believe prednisone also effects your immune system in a similar way as a disease.

I wonder how your physicians could rule out avascular necrosis? I have avascular necrosis in both hips from prednisone. It can also be caused by trauma or alcoholism.

It took 9 mos. before I found a physician willing to approve an MRI, ironically he is an orthopedic surgeon specializing in back surgery. An orthopedic surgeon specializing in hips and knees said there was nothing wrong with me since was able to hop up on exam table without pain - my left hip was the problem and used my right leg to get on the table! A rheumatologist determined nothing was wrong with me after having walked three steps on my heels.

The orthopedic surgeon that diagnosed my problem sent me to a hip specialist in his practice said my left hip ball and socket had collapsed and the right hip was on its way.

To make understanding more difficult, I've asked physicians if it requires long term high doses of prednisone or can short term - 10 days - cause the problem. The physicians were split on their opinion.

I have yet to find out whether or not avascular necrosis is progressive.

I'm sorry for the rant reply, but there you have another person's experience.