Antiphospholipid score is a novel risk factor for idiopathic osteonecrosis of the femoral head in patients with systemic lupus erythematosus

Hisada, Ryo; Kato, Masaaki; Ohnishi, Naoki; Sugawara, Eri; Fujieda, Yuichiro; Oku, Kenji; Bohgaki, Toshiyuki; Amengual, Olga; Yasuda, Shinsuke; Atsumi, Tatsuya

doi:10.1093/rheumatology/key365

Cited by 21 publications

(25 citation statements)

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“…that usage of 0.8 mg/(kg/day) of prednisone was associated with ON. 21 Other studies have shown that a daily dose of 20–39 mg for >1 month increased the risk of ON, 5,12,22 as well as >40 mg for 1 month. 23 Some studies emphasized that the cumulative dose of GC in the first month or first 4 months at SLE onset could be used as a predictor to evaluate the occurrence of ON.…”

Section: Discussionmentioning

confidence: 98%

Risk of osteonecrosis in systemic lupus erythematosus: An 11-year Chinese single-center cohort study

Long

Zhang

You

et al. 2021

Lupus

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Objective Osteonecrosis (ON), which can lead to physical disability, is a common complication of systemic lupus erythematosus (SLE). The purpose of this study was to determine the prevalence of ON and identify possible risk factors in Chinese SLE patients. Methods SLE patients who fulfilled the 1997 American College of Rheumatology SLE classification criteria were recruited from the Peking Union Medical College Hospital. The chi-square test (χ 2 test) and multivariate regression analyses were used to evaluate risk factors. The Cox proportional-hazards model was used to construct the survival curves and estimate the simultaneous effects of prognostic factors on survival. Results We consecutively enrolled 1,158 patients, of which 88 patients (7.6%) developed ON. Among ON patients, 57.1% of patients had isolated femoral head necrosis and 42.9% had multiple joint involvement. The mean age of ON patients (24.62 ± 8.89 years) was significantly younger than SLE patients without ON (27.23 ± 10.16 years, p = 0.09). The ON group presented with a much longer disease course (10.68 ± 5.97 years, p < 0.001) and increased incidence of arthritis, kidney, and central nervous system (CNS) involvement (65.9% [ p < 0.05], 57.6% [ p < 0.05], and 16.5% [ p < 0.05], respectively, in the ON group). ON patients were more likely to be treated with glucocorticoid (GC) and to receive a high dose of prednisolone at the initial stage of SLE ( p < 0.05). The percentage of patients who received hydroxychloroquine was much higher in the control group ( p < 0.001). Cox regression analysis suggested that CNS involvement and GC therapy were two independent risk factors for ON in SLE patients. The presence of anti-phospholipid antibodies (aPLs) was a risk factor for multiple joint necrosis (odds ratio: 6.28, p = 0.009). Conclusions ON remains a serious and irreversible complication in SLE. In addition to glucocorticoid therapy, we found that CNS system involvement was a risk factor for ON, while the administration of hydroxychloroquine was a protective factor. The clinical characteristics of multiple site ON patients were distinct from isolated femoral head necrosis patients. The presence of aPLs was a risk factor for multiple site osteonecrosis.

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Section: Discussionmentioning

confidence: 98%

Risk of osteonecrosis in systemic lupus erythematosus: An 11-year Chinese single-center cohort study

Long

Zhang

You

et al. 2021

Lupus

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“…All of them were also receiving therapy for osteoporosis. High-dose corticosteroid may decrease bone formation rapidly and permanently, and increase bone resorption rapidly and temporarily [24]. Indeed, corticosteroid induced osteoblast and osteocyte apoptosis may be the common mechanisms for osteoporosis and AVN [25].…”

Section: Discussionmentioning

confidence: 99%

Avascular necrosis less frequently found in systemic lupus erythematosus patients with the use of alternate day corticosteroid

et al. 2020

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evaluation of symptomatic or asymptomatic patients [3]. The risk factors for AVN in SLE patients were shown to be young age, sex, cushingoid body habitus, Raynaud's phenomenon, thrombophlebitis, vasculitis, nephritis, cerebritis, interstitial pneumonitis, pleural effusion, antiphospholipid syndrome, preeclampsia, hypertension, anemia, thrombocytopenic thrombotic purpura, smoking, and migraine [4]. The objective of this study was to evaluate associated factors for the development of AVN in our SLE cohort. Materials and methodsA total of 127 consecutive SLE patients (86.6% female) were enrolled in this cross-sectional study during 10 months in our outpatient clinic. Ethical approval was received from the local ethical committee. Inclusion criteria of this study were being ≥18 years old and fulfillment of the 1997 American College of Rheumatology (ACR) revised criteria for the classification of SLE [5].Demographic data, clinical, and laboratory features were recorded from a standard questionnaire and from the patients' files. Potential associated factors of AVN such as sex, age, body mass index, age at disease diagnosis, disease duration, smoking history, hypertension, diabetes mellitus, coronary artery disease, hyperlipidemia, anemia, osteoporosis, menopause, SLE disease activity score, antiphospholipid antibodies positivity, and corticosteroid usage were noted.SLE disease activity index score (SLEDAI-2K) [6] was recorded for assessment of disease activity. SLEDAI scores were also calculated according to the situation 6 months prior to AVN diagnosis.Background/aim: Avascular necrosis (AVN) is the death of bone due to compromise of blood flow. The etiology of AVN is multifactorial; corticosteroid usage is the second most significant factor after trauma, and systemic lupus erythematosus (SLE) is the most common underlying disease. The objective of this study was to assess the factors of AVN in SLE patients. Materials and methods:The study included 127 patients with SLE who fulfilled 1997 American College of Rheumatology (ACR) revised criteria. Demographic data, age at SLE diagnosis, disease duration, disease activity, body mass index, clinical findings, antiphospholipid syndrome, steroid usage, dose and duration, comorbid diseases, and smoking history were recorded.Results: AVN was found in 11 of 127 (8.7%) SLE patients. Hyperlipidemia (P < 0.001), cushingoid body habitus (P < 0.001), and proteinuria (P = 0.013) were found at higher rates in the AVN group. All of the 11 AVN cases had osteoporosis (P < 0.02). In multivariate regression analysis, daily steroid usage was the only factor for development of AVN in SLE. Conclusion:The hypothesis of our study was that an alternate day steroid regimen may decrease AVN frequency in SLE patients.

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“…To date, there have been many reports on risk factors for AVN development in SLE patients 19,20 . Although the results of studies are different, the use of corticosteroid, cumulative corticosteroid dose, immunosuppressive agents, neuropsychiatric involvement, antiphospholipid antibodies have been associated with AVN development in SLE patients 19,20 . However, there are few reports on the frequency and risk factors for AVN development in jSLE patients.…”

Section: Discussionmentioning

confidence: 99%

Çocukluk çağı başlangıçlı sistemik lupus eritematozus hastalarında avasküler nekrozis sıklığı

Balcı

Ekinci

Pişkin

et al. 2020

Cukurova Medical Journal

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Öz Purpose: Avascular necrosis (AVN) is a debilitating complication of juvenile systemic lupus erythematosus (jSLE). The aim of this study was to evaluate the frequency and clinical characteristics of patients with AVN in jSLE from a single center. Material and Methods: Fifty-eight jSLE patients diagnosed according to the American College of Rheumatology classification criteria were included in this retrospective study. Disease activity of jSLE patients was measured by SLE Disease Activity Index-2K (SLEDAI-2K), organ damage was determined by the pediatric version of the systemic lupus international collaborating clinics/American College of Rheumatology damage index (pedSDI) at last visit. Results: Among 58 jSLE patients, the female patients accounted for 86.2% (n=50). Mean baseline SLEDAI-2K score was 21.47±8.96. The number of patients with at least one damage item of pedSDI was 24 (41.4%), in which 5 patients (8.6%) had AVN. There were no statistical differences between the groups except baseline complement 3 (C3) level was significantly lower in patients with AVN. Conclusion: Baseline low C3 level might be a predictor for AVN development in jSLE patients.There is unmet need for multicenter studies investigating possible risk factors of AVN in jSLE patients. Amaç: Avasküler nekrozis (AVN), çocukluk çağı başlangıçlı sistemik lupus eritematozusun (jSLE) yıkıcı bir komplikasyonudur. Tek merkezden yapılan bu çalışmanın amacı jSLE hastalarında AVN sıklığını ve bu hastaların klinik özelliklerini belirlemektir. Gereç ve Yöntem: Amerikan Romatoloji Koleji'nin sınıflama kriterlerine göre tanı almış 58 jSLE hastası bu geriye dönük çalışmaya dahil edildi. jSLE hastalarının hastalık aktiviteleri SLE hastalık aktivite indeksi baz alınarak (SLEDAI-2K) ölçüldü. Organ hasarı Amerikan Romatoloji Koleji'nin SLE hastalarında uyguladığı hasar indeksinin çocukluklardaki versiyonu kullanılarak son muayenede belirlendi. Bulgular: Elli sekiz jSLE hastasının %86,2 (50)'si kız hastaydı. Ortalama bazal SLEDAI-2K skoru 21,47±8,96 idi. En az bir organda hasarı olan hasta sayısı 24 (%41,4) idi, bunlardan 5 tanesinde (%8,6) AVN vardı. AVN olan ve olmayan hastalar arasında çeşitli değikenlere göre istatistiksel anlamlı bir farklılık saptanmadı. Sadece bazal kompleman 3 (C3) düzeyi AVN hastalarında, AVN olmayan hastalara göre anlamlı olarak düşüktü. Sonuç: Bazal düşük C3 düzeyi jSLE hastalarında AVN gelişimini tahmin etmede ön görücü olabilir. jSLE hastalarında AVN gelişimi için muhtemel risk faktörlerini inceleyen çok merkezli çalışmalara ihtiyaç vardır.

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Antiphospholipid score is a novel risk factor for idiopathic osteonecrosis of the femoral head in patients with systemic lupus erythematosus

Cited by 21 publications

References 12 publications

Risk of osteonecrosis in systemic lupus erythematosus: An 11-year Chinese single-center cohort study

Risk of osteonecrosis in systemic lupus erythematosus: An 11-year Chinese single-center cohort study

Avascular necrosis less frequently found in systemic lupus erythematosus patients with the use of alternate day corticosteroid

Çocukluk çağı başlangıçlı sistemik lupus eritematozus hastalarında avasküler nekrozis sıklığı

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