Corticosteroid-associated Osteonecrosis: A Rare, but Serious, Complication in Uveitis

• Published in: Ocular immunology and inflammation Vol. 21; no. 2; pp. 102 - 107
• Main Authors: Smith, Wendy M., Larson, Theresa A., Meleth, A. Dhanu, Krishnadev, Nupura, Nussenblatt, Robert B., Sen, H. Nida
• Format: Journal Article
• Language: English
• Published: England Informa Healthcare USA, Inc 01.04.2013; Taylor & Francis
• Subjects: Adolescent; Adult; avascular necrosis; corticosteroid; Female; Follow-Up Studies; Glucocorticoids - adverse effects; Glucocorticoids - therapeutic use; Humans; Incidence; Male; Middle Aged; osteonecrosis; Osteonecrosis - chemically induced; Osteonecrosis - diagnosis; Osteonecrosis - epidemiology; prednisone; Prevalence; Retrospective Studies; Risk Factors; United States - epidemiology; uveitis; Uveitis - diagnosis; Uveitis - drug therapy; Young Adult; United States
• ISSN: 0927-3948; 1744-5078
• DOI: 10.3109/09273948.2012.740129

Abstract Purpose: To examine the incidence and prevalence of osteonecrosis in uveitis patients. Methods: An electronic medical record database search was conducted to identify uveitis patients with osteonecrosis and the number at risk for corticosteroid-related osteonecrosis from 2003 to 2012. The clinical and ophthalmologic features of the uveitis patients with osteonecrosis were assessed with retrospective chart reviews. Results: Six uveitis patients with osteonecrosis were identified, comprising a prevalence of 1.5%. The incidence density was 0.19 per 100 person-years of follow-up. The uveitides included sarcoidosis, sympathetic ophthalmia, idiopathic retinal vasculitis, idiopathic chronic anterior and intermediate uveitis, Vogt-Koyanagi Harada disease, and Cogan syndrome. The duration of systemic corticosteroid treatment ranged from 6 weeks to 6 years. The potential systemic risk factors were Raynaud phenomenon, antiphospholipid and autoantibodies, sickle cell trait, and thalassemia. Conclusions: Although osteonecrosis appears to be a rare complication among uveitis patients, physicians should strive to minimize systemic corticosteroid use when appropriate. A higher level of suspicion for osteonecrosis may be warranted in patients with additional systemic risk factors.