Article
Is osteonecrosis of the lunate bone a feature of systemic sclerosis? A case series of nine patients and review of the literature
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Published: | September 12, 2014 |
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Background: The aim of the present case series was to study the presence of osteonecrosis of the lunate bone in patients with systemic sclerosis (SSc).
Methods: 9 SSc patients (5 limited and 4 diffuse SSc) were evaluated by clinical examination, radiography of the hands, low-field magnetic resonance imaging (MRI) of the wrists, duplex sonography of the distal upper extremity arteries and nailfold videocapillaroscopy (NVC). Additionally, a review of the literature with respect to lunate osteonecrosis was performed.
Results: At first examination, all 9 SSc patients had typical signs of osteonecrosis of the lunate bone in MRI. However, only one patient was diagnosed by conventional radiography and another patient retrospectively had minor changes of the lunate bone (thus 7 patients had early non-radiographic stages).
Out of 5 patients, who agreed to a follow-up MRI examination (mean 3.2 years between MRI studies), all showed at least constant signal alterations and two patients a progressive destruction of the lunate bone. With regard to conventional radiography, 5 of 7 patients switched to radiographic stages during the course of the disease (one patient developed definite signs of osteonecrosis, 4 patients had minor changes of the lunate bone, one patient had no sign of lunate bone affection even in computed tomography, one patient without radiography). 8 patients reported wrist pain for at least one episode, but only 2 patients reported wrist pain at time of follow-up.
All SSc patients had severe Raynaud’s phenomenon and a pathologic NVC SSc pattern. Macrovascular involvement of the ulnar artery was observed in 3 patients: one patient with unilateral and 2 patients with bilateral occlusion. Besides long-term low-dose corticosteroid use in 5 patients and repeated cortisone pulse-therapy in one patient, no other typical risk factors for osteonecrosis were present.
In the literature, six cases of SSc patients with coexistent osteonecrosis of the lunate bone have been published. An analysis of potential underlying mechanisms has not been performed yet.
Conclusion: Our results suggest that osteonecrosis of the lunate bone is often clinically silent but more frequent than previously thought and might be a consequence of SSc vasculopathy itself rather than typical risk factors for osteonecrosis.