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Advanced ARCO stage at the onset of ON is an independent risk factor for THR in SLE patients with ON. In ARCO stage I-III ON, patients with NPSLE and those receiving > 0.9 g prednisolone during the first six months after the ON diagnosis are likely to require THR.

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Although extensive evidence indicates that free fatty acids can decrease glucose utilization in vitro, it is still controversial how an increase in lipolysis affects glucose metabolism in man. To test the hypothesis that an increase in lipolysis is related to insulin resistance, we examined the effect of lipid-heparin infusion on glucose metabolism in ten normal subjects by the euglycaemic glucose clamp technique and isotopic determination of glucose turnover. In the control euglycaemic clamp studies with insulin infusion at 0.2 and 1.0mU.kg-l.min -1, endogenous glucose production was suppressed from the basal rate of 2.0+_0.3 mg. kg-lmin -1 to 1.1 _+0.7 mg.kg -1.min -I and -0.4+_0.7 mg. kg-lmin -1 respectively. Glucose utilization increased from the basal rate of 2.0+_0.3 mg.kg-lmin -1 to 2.3+_0.5 mg. kg-lmin -1 and 5.9+1.8 mg.kg-lmin -1 respectively. When the euglycaemic clamp studies were coupled with lipid-heparin infusion at comparable low and high rates of insulin infusion, endogenous glucose production increased (1.8+ 0.7 mg.kg -1.rain -1, p<0.001, and 0.3 +_0.6mg.kg -1. min -1, p<0.05, respectively), and glucose utilization decreased (2.1+_0.3mg.kg-l.min -1, not significant, and 3.2 +_ 0.7 rag. kg-1. rain-i, p< 0.001 respectively). These data suggest that the artificial induction of intravascular lipolysis by lipid-heparin infusion leads to a state of insulin resistance in man.