Temporal course of avascular femoral head necrosis in patients with pemphigus vulgaris.

Abstract

Pemphigus vulgaris (PV) is typically treated with systemic corticosteroids and immunosuppressive agents. Avascular necrosis (AVN) of the femoral head is a well-recognized major complication of corticosteroid therapy. The characteristics of this serious complication in PV remain unknown. Uncontrolled, retrospective study of all PV-related AVN cases diagnosed at an Iranian autoimmune bullous disease clinic between 1985 and 2013. Of the 2,321 medical records of PV patients reviewed, 45 (1.93%) cases showed femoral AVN, with 30 (66.7%) individuals being male. The mean age at diagnosis of AVN was 47.4 ±14.2 years. The mean interval between the diagnosis of PV and the onset of AVN was 25.3 ±18.3 months. With the exception of eight cases (17.8%), the majority of patients developed AVN within three years after the diagnosis of PV. Themean cumulative dose of prednisolone in patients with AVN was 13,115.8 ±7041.1mg. There was a strong correlation between the total prednisolone dose and the time of onset of AVN (p=0.001). In patients with a history of alendronate intake, that interval was significantly shorter (p=0.01). Occurring in about 2% of patients, AVN is a serious complication of corticosteroid treatment in patients with PV, predominantly in the first three years of treatment. In individuals receiving higher doses of prednisolone, AVN tends to occur earlier.