{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T23:42:57Z","timestamp":1768434177365,"version":"3.49.0"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T00:00:00Z","timestamp":1603065600000},"content-version":"vor","delay-in-days":292,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Osteonecrosis (ON) is characterized by cellular death of bone components due to interruption of blood supply that leads to bone ischemia and potential joint destruction. There are multiple risk factors and medical condition associated with ON, including systemic lupus erythematosus (SLE). The most common sites of ON are the femoral head, distal femur, proximal humerus, talus and lumbar spine. Very few cases of nontraumatic ON in distal tibia have been reported in the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Illustration<\/jats:title>\n                    <jats:p>We present a case of 23-year-old female diagnosed with osteonecrosis of distal tibia and history of SLE. The patient also had history of avascular necrosis of right hip and underwent right total hip arthroplasty. We treated the patients with conservative treatment for intial management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The risk of ON in SLE patients is likely due to the results of both the SLE itself and use of corticosteroids. Systemic inflammation in SLE reduces the development of osteoblasts, increases osteoclast maturation and activity and increases protohrombotic agents that can lead to rapid bone loss. Corticosteroids are the most consistent risk factor associated with the development of ON in SLE. Conservative medical management is effective in the early stages of the disease before bone collapse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite advances in the diagnosis and treatment of SLE, symptomatic ON continues to be a significant comorbidity. Strategies to detect and manage early stage ON is necessary to prevent the progression of this serious complication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2020.10.069","type":"journal-article","created":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T03:49:29Z","timestamp":1603856969000},"page":"126-128","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Osteonecrosis of the distal tibia in systemic lupus erythematosus"],"prefix":"10.1097","volume":"77","author":[{"given":"Ihsan","family":"Oesman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danarto Hari","family":"Adhimukti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R2-30-20260114","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1053\/j.jfas.2016.04.001","article-title":"Nontraumatic osteonecrosis of the distal tibia: a case presentation and review of the literature","volume":"56","author":"McLeod","year":"2017","journal-title":"J. Foot Ankle Surg"},{"key":"R3-30-20260114","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1385\/CRIAI:25:1:13","article-title":"Osteonecrosis in patients with SLE index entries","volume":"25","author":"Abu-shakra","year":"2003","journal-title":"Clin. Rev. Allergy Immunol"},{"key":"R4-30-20260114","doi-asserted-by":"crossref","first-page":"2521","DOI":"10.2169\/internalmedicine.54.4868","article-title":"Multiple osteonecrosis with systemic lupus erythematosus","volume":"54","author":"Sargin","year":"2015","journal-title":"Intern. 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Surg"},{"key":"R9-30-20260114","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s10067-017-3820-5","article-title":"Systemic lupus erythematosus patients with high disease activity are associated with accelerated incidence of osteonecrosis: a systematic review and meta-analysis","volume":"37","author":"Zhang","year":"2018","journal-title":"Clin. Rheumatol"},{"key":"R10-30-20260114","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.3899\/jrheum.170837","article-title":"Monitoring of osteonecrosis in systemic lupus erythematosus: a systematic review and metaanalysis","volume":"45","author":"Hussein","year":"2018","journal-title":"J. Rheumatol"},{"key":"R11-30-20260114","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/S0889-857X(05)70139-3","article-title":"Management of osteonecrosis in systemic lupus erythematosus","volume":"26","author":"Mont","year":"2000","journal-title":"Rheum. Dis. Clin. 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