American Board of Internal Medicine (ABIM) Certification Practice Exam

In the context of systemic lupus erythematosus, what is the main reason to evaluate for osteonecrosis?

1. Fatigue

2. Joint pain or limitation of motion

3. Skin rashes

4. Neurological symptoms

The correct answer is: Joint pain or limitation of motion

Evaluating for osteonecrosis in patients with systemic lupus erythematosus is primarily concerned with joint pain or limitation of motion. Osteonecrosis, also known as avascular necrosis, occurs when there is a disruption of blood supply to the bone, leading to bone death and subsequent joint dysfunction. In systemic lupus erythematosus, the use of glucocorticoids for management of disease flares significantly increases the risk of osteonecrosis, particularly in weight-bearing joints such as the hip and knee. Patients may present with joint pain that can indicate either inflammatory arthritis related to lupus or the development of osteonecrosis. As osteonecrosis progresses, it can lead to a decrease in joint mobility and functional limitations, making it essential for clinicians to assess joint symptoms in these patients. While fatigue, skin rashes, and neurological symptoms can occur in systemic lupus erythematosus, they are not directly associated with the risk of osteonecrosis or the consequent joint-related complications that necessitate evaluation for this serious condition. Thus, joint pain or limitation of motion serves as a critical clinical indicator for the assessment of osteonecrosis in this patient population.