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Case Reports in Rheumatology
Volume 2014, Article ID 515361, 3 pages
http://dx.doi.org/10.1155/2014/515361
Case Report

A Debilitating Orthopaedic Complication following Corticosteroid Therapy for Polymyalgia Rheumatica

1Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK
2Gloucestershire NHS Trust, UK

Received 6 November 2013; Accepted 27 November 2013; Published 6 April 2014

Academic Editors: D. Melchiorre, J. Mikdashi, P. Prete Md, and M. Soy

Copyright © 2014 Paul Rai and Vinay Takwale. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Avascular necrosis (AVN) of the scaphoid secondary to corticosteroid use is a rare entity. Previous reports in the literature refer to chronic steroid intake. We report a case secondary to low dose, short term use. AVN has a multifactorial cellular and genetic aetiology and most frequently affects the femoral head. Diagnosis relies on a high index of suspicion and early magnetic resonance (MR) scanning. Treatment options are similar to those of traumatic scaphoid nonunions and include vascularised bone grafting and scaphoid excision. Polymyalgia Rheumatica is a common condition and its treatment is led by corticosteroid use. Mild to moderate strengths are advocated. However in our report we show that even with small doses serious adverse effects can be encountered.