One of the complications of glucocorticoid therapy is osteonecrosis (ON). While usually affecting only one joint, some patients develop osteonecrosis in multiple joints (MJON).
Criteria for glucocorticoid-induced osteonecrosis: oral or intravenous glucocorticoid therapy started >= 6 months prior to the diagnosis of osteonecrosis
Criteria for multiple joint involvement: >=3 joints with osteonecrosis
Joints affected may include:
(1) femoral head
(2) knee
(3) shoulder
(4) ankle
A patient with MJON have greater disability and pain.
Risk factors for MJON:
(1) higher cumulative oral dose of steroids (increased 3.2% for each 1,000 mg)
(2) longer duration of therapy (which impacts the cumulative dose)
(3) SLE
(4) hematologic malignancy
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