Osteonecrosis of the femoral head (ONFH) develops in nearly 18% of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, according to a recent study that investigators believe is the first to quantify the prevalence of this complication.

The study also found that a prednisolone dose of 20 mg/day or higher on day 90 of remission induction therapy (RIT) is an independent risk factor for ONFH, investigators reported in RMD Open.

The findings are based on a study of 186 patients with ANCA-associated vasculitis by Norihiro Mimura, MD, of Chiba University in Chiba, Japan, and colleagues. Of these, 33 (17.7%) were diagnosed with ONFH: 55% who were asymptomatic and 64% who had bilateral ONFH.

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“ONFH causes collapse of the femoral head and dysfunction of the hip joint, resulting in a decline in quality of life,” the authors explained.

The investigators noted that 76% of ONFH joints were in precollapse stages (stage 2 or lower), and 24% were in collapse stages (stage 3 or higher). In addition, 56% of the precollapse stage joints already were at risk for future collapse.

Prednisolone doses of 20 mg/day or higher were independently associated with significant 7.2% increased odds of ONFH, Dr Mimura and colleagues reported.

The authors said their results suggest that a rapid reduction of glucocorticoids in RIT and early magnetic resonance imaging screening for detecting precollapse ONFH are important for decreasing and intervening in the development of ONFH in patients with ANCA-associated vasculitis.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Mimura N, Iwamoto T, Furuta S, et al. Prevalence and risk factors of osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a multicentre cohort study. RMD Open. 2023;9:e002787. doi:10.1136/rmdopen-2022-002787