Эндопротезирование суставов у пациентов с системной красной волчанкой

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This article describes a case series of total joint replacement in 4 patients with systemic lupus erythematosus affecting the hip and knee joints. The average age of patients at the time of arthroplasty was 34 years. All patients were female and all received glucocorticosteroid therapy at varying doses of 5 to 10 mg per day. At the debut of the lupus erythematosus system, median activity index was 10 points. In one patient, remission of systemic lupus erythematosus was induced by mycophenolate mofetil, in another, by azathioprine. In total, three total arthroplasty were performed for aseptic necrosis of the head of the hip joint and one more arthroplasty due to severe osteoarthritis of the knee joint. At the time of arthroplasty in one clinical case a complete remission of systemic lupus erythematosus was observed, in three patients there was an incomplete remission. All components of the endoprostheses were stable, with no signs of osteolysis.In all cases, as a result of arthroplasty, a good effect was noted with increase in the functional activity of the hip and knee joints and decrease in pain. None of the patients had a recurrence of systemic lupus erythematosus and development of postoperative complications (except for the need for blood transfusion).Our own experience indicates the potentially high efficiency and relative safety of total hip and knee arthroplasty in patients with systemic lupus erythematosus, including in cases of severe disease with unfavorable prognostic factors. To reduce the risk of postoperative complications (primarily thromboembolism, infections, late delayed neutropenia), total arthroplasty should be performed during the period of remission of systemic lupus erythematosus in conditions of control of comorbid conditions and close cooperation between rheumatologists and orthopedic surgeons.Key words: systemic lupus erythematosus, total arthroplasty, hip joint, knee joint, aseptic necrosis, mycophenolate mofetil, azathioprine.