A North Carolina Woman with Lupus, AVN Hips, now AVN Shoulder
AVN is complicated enough, adding Lupus, Rheumatoid arthritis, long term corticosteroid usage, and multi-joint AVN to the equation makes it far more complicated. Especially when both hips have been replaced due to advanced AVN, and now the AVN is in the shoulders. This is the history a 46-year-old North Carolina woman gave to Dr. Lox. Not an easy story, but nothing new to Dr. Lox.
The Problem with Systemic Associated AVN
Trauma is the leading cause of AVN or avascular necrosis. Next is idiopathic or unknown, following that are many systemic associated factors such as excessive Corticosteroid usage and Autoimmune disorders like Lupus and Rheumatoid Arthritis. Dennis M. Lox M.D. is a Sports and Regenerative Medicine expert, with special expertise in AVN. Dr. Lox has treated many Autoimmune-associated AVN cases, however, Dr. Lox notes that an overwhelming number have been treated with excessive Corticosteroids. This makes understanding cause and effect difficult, as many Rheumatologists continue to treat the Autoimmune flares of Lupus or RA with corticosteroids. It may be that the corticosteroids were the underlying culprit all along. Some of the Autoimmune disorders are associated with vasculitis which can indeed cause impaired blood flow to the bone. However, vasculitis is not seen in all these autoimmune cases with AVN. Avascular necrosis is sometimes referred to as osteonecrosis. AVN occurs when the blood supply to a region of bone is impaired leading to bone cell death. Corticosteroids may affect the blood flow directly at the bone blood vessel interface.
When Hips and Shoulders both Have AVN
Systemic AVN as opposed to traumatic AVN may occur in multiple areas and may show up at different time intervals. Making it almost like a ticking time bomb, once it has been diagnosed in one area. This patient was diagnosed with AVN of both hips and shoulders. The AVN was first diagnosed after continued hip pain for several months. There was no trauma. An MRI revealed AVN of both hips. She eventually had hip replacement surgery to both hips 3 years ago. This year she began having pain in both shoulders. Her right shoulder was worse than her left shoulder, and she is right hand dominant, so it was more troublesome for her. This led to her eventually having MRI’s of both shoulders. Right-handed rotator cuff frayed supraspinatus tear, a small focal area of AVN. Right shoulder much more pain than left. Left small well-defined area of AVN superior femoral head no collapse no moderate pain. She is now on biologics, she was intermittently given high doses of corticosteroids when she had flare-ups of her Lupus or RA for up to 6 months at a time. She has stopped taking the steroids since her diagnosis of AVN. After having both hips replaced in 2016, and her recent diagnosis of shoulder AVN, she doesn’t want a total shoulder replacement, so she researched Regenerative Medicine and Dr. Lox.
Dr. Lox has treated nearly every type of risk factors for AVN and nearly every joint. The experience has allowed him to advise young athletes, professional athletes with AVN, and patients from all age groups with systemic associated AVN affecting multiple joints.
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