# Inflammatory Arthritis Uncovered Through Imaging of Osteonecrosis: A Case Series

## TL;DR

This study shows that imaging for osteonecrosis can reveal hidden inflammatory arthritis, even without typical symptoms or steroid use.

## Contribution

The paper introduces a novel observation linking inflammatory arthritis to osteonecrosis through imaging findings in patients without steroid history.

## Key findings

- MRI scans in three patients with osteonecrosis revealed signs of undiagnosed inflammatory arthritis.
- Features like synovitis and erosions prompted further evaluation for inflammatory arthritis despite no clinical symptoms.
- None of the patients had a history of steroid use, suggesting a possible new pathophysiological link.

## Abstract

Osteonecrosis (ON) is typically viewed as an isolated condition stemming from vascular compromise. We present a three-case series demonstrating that MRI, performed to confirm the diagnosis of ON, incidentally revealed features consistent with underlying, previously undiagnosed inflammatory arthritis (IA). Even in the absence of typical clinical features, the presence of imaging findings such as synovitis, tenosynovitis, and erosions should prompt a thorough clinical and serological evaluation for coexisting IA. An interesting point to note is that none of the three patients reported a history of steroid use. This manuscript aims to highlight a possible pathophysiological link between IA and ON.