My Journey with RA, Hip Pain, Steroid Use, and Avascular Necrosis
In January 2023, I went through extensive testing for ongoing left hip pain. I had been in pain with my left hip since July of 2022. Honestly, I thought it was in relation to a flare of my rheumatoid arthritis (RA) that I had been experiencing. However, the pain continued on long after my flare resolved.
What is avascular necrosis (osteonecrosis)?
Imaging results revealed that I had a tear in the cartilage of my left hip. It also revealed that I had osteonecrosis (also called avascular necrosis) in both of my hips. The Mayo Clinic defines avascular necrosis as "the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to tiny breaks in the bone and cause the bone to collapse."1
It appears from imaging that I am thankfully in the early stages of the disease.
The importance of healthcare team collaboration
I am very fortunate that my rheumatologist, physical therapist, and orthopedic doctor work well together. As the orthopedic doctor is focusing on pain relief and further diagnostic testing in my hips, my physical therapist is working to address the muscle imbalance and complete dysfunction that is occurring with walking and performing my daily activities.
In coordination with my healthcare team, my rheumatologist is running some further testing to get to a potential root cause of the avascular necrosis (osteonecrosis) in both of my hips. She is ruling out the potential of some other autoimmune conditions that could be involved with this diagnosis. This team collaboration is key to treat the complexity of the diagnosis.
Steroid use as a risk factor
Throughout my almost 19-year journey with rheumatoid arthritis, there have been periods of time that I have had to use steroids such as prednisone, dexamethasone, and cortisone to help combat the inflammation associated with my rheumatoid arthritis.
My rheumatologist did state that steroid use has been researched and linked to avascular necrosis (osteonecrosis). She is running further antibody tests and testing for other potential autoimmune conditions. However, my rheumatologist definitely wanted me to be aware of the link.
Do the benefits outweigh the risks?
Honestly, I realize that I take a risk with anything that I ingest into my body. I also know that those of us living with chronic conditions like rheumatoid arthritis understand that there are times when the benefits outweigh the risks. When my ability to function in my daily life has been affected by the severe inflammation and pain from my rheumatoid arthritis, then I don’t regret using the medication.
Increasing awareness about avascular necrosis (osteonecrosis)
I hope this article helps to bring awareness to our community about avascular necrosis (osteonecrosis). I encourage you all — if you are experiencing hip pain that is lasting beyond what you would expect for a disease flare — to please have a conversation with your doctor. Do not just brush it off as "just being your rheumatoid arthritis." Early detection of any disease process is vital.
As I continue to gain more information, I will definitely be writing a follow-up article. We live with a very complicated disease, and it is so important to talk about issues like this.
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