In some patient populations, there appears to be a weak link between corticosteroids and the development of avascular necrosis. Many of the
groups that had weak links included patients who had inflammatory arthritis (excluding systemic lupus erythematosus), who many authors do not consider as having true hip avascular necrosis. However, in most
studies, an association was found between increasing corticosteroid exposure and risk. In addition, an incremental effect was observed, where increasing dosages led to a higher incidence of this disease.
The radiograph demonstrates AVN of the humeral head and early collapse of the articular surface. Patients with radiographic evidence of proximal humerus AVN should also have hip radiographs performed as part of their evaluation.
Cruess reviews 95 patients with steroid-induced AVN of the humeral head reporting success with both conservative and arthroplasty treatment.
L'insalata et al reviews 65 shoulders with AVN of the humeral head reporting mixed results with 35 shoulders requiring arthroplasty after failure of conservative therapies. Surgical drilling and decompression did not alter the progression of disease.
Answers 1, 2, 3, and 5 describe rheumatoid arthritis, Reiter's Syndrome, gout, and septic arthritis respectively.