Temporal Course of Avascular Femoral Head Necrosis in Patients With Pemphigus Vulgaris; [Zeitlicher Verlauf Der Avaskularen Nekrose Des Huftkopfes Bei Patienten Mit Pemphigus Vulgaris] Publisher Pubmed



Balighi K¹ ; Daneshpazhooh M¹ ; Aghazadeh N¹ ; Saeidi V¹ ; Shahpouri F¹ ; Hejazi P¹ ; Chamsdavatchi C¹ Show Affiliations
Source: JDDG - Journal of the German Society of Dermatology Published:2016

Abstract

Background and objectives: 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. Patients and methods: Uncontrolled, retrospective study of all PV-related AVN cases diagnosed at an Iranian autoimmune bullous disease clinic between 1985 and 2013. Results: 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. The mean cumulative dose of prednisolone in patients with AVN was 13,115.8 ± 7041.1 mg. 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). Conclusions: 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. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.