Avascular (Aseptic) Bone Necrosis Associated with Systemic Lupus Erythematosus

Dubois, Edmund L.

doi:10.1001/jama.1960.03030080028005

Cited by 207 publications

(77 citation statements)

References 5 publications

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“…This form of confounding is defined as a situation in which the association between a treatment (e.g., corticosteroid) and a health-related outcome is distorted because the treatment tends to be given when there is more severe disease, and disease severity also influences the outcome under study (e.g., chronic cognitive dysfunction). As alluded to previously, SLE activity may also contribute directly to the other damage items under study, including vascular disease (23,24), osteoporosis (13), and AVN (34,35). Thus, an important limitation of this study is that we cannot independently study the effect of the disease activity for which the corticosteroid was prescribed.…”

Section: Discussionmentioning

confidence: 93%

Damage in systemic lupus erythematosus and its association with corticosteroids

Zonana-Nacach

Barr

Magder

et al. 2000

Arthritis & Rheumatism

441

244

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Objective. To evaluate the association between corticosteroid use and organ damage in patients with systemic lupus erythematosus (SLE).Methods. The occurrence and date of organ damage, as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, were determined for 539 patients enrolled in the Hopkins Lupus Cohort Study. The risk of damage associated with the cumulative prednisone dose, high-dose prednisone (>60 mg/day for >2 months), and pulse methylprednisolone (1,000 mg intravenously for 1-3 days) was estimated using Cox proportional hazards regression analyses, controlling for age, race, and sex. Risk estimates for the cumulative prednisone dose were based on a reference dose of 36.5 gm (e.g., 10 mg of prednisone daily for 10 years [or equivalent]).Results. The cumulative prednisone dose was significantly associated with the development of osteoporotic fractures (relative risk [RR] 2.5, 95% confidence interval [95% CI] 1.7, 3.7), symptomatic coronary artery disease (RR 1.7, 95% CI 1.1, 2.5), and cataracts (RR 1.9, 95% CI 1.4, 2.5). Each intravenous pulse was associated with a small increase in the risk of osteoporotic fractures (RR 1.3, 95% CI 1.0, 1.8); however, this result failed to reach statistical significance (P ‫؍‬ 0.07). Each 2-month exposure to high-dose prednisone was associated with a 1.2-fold increase in the risk of both avascular necrosis (95% CI 1.1, 1.4) and stroke (95% CI 1.0, 1.5).Conclusion. SLE patients receiving long-term prednisone therapy were at significant risk of morbidity due to permanent organ damage. Additional research is required to determine the relative contributions of SLE disease activity and corticosteroids to the pathogenesis of specific types of organ damage. Furthermore, new steroid-sparing therapies are needed in order to treat disease activity and minimize cumulative and high-dose prednisone exposure.

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Section: Discussionmentioning

confidence: 93%

Damage in systemic lupus erythematosus and its association with corticosteroids

Zonana-Nacach

Barr

Magder

et al. 2000

Arthritis & Rheumatism

441

244

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“…There have been many case reports about steroid-or alcohol-related osteonecrosis of the femoral condyle (Dubois and Cozen 1960, Hall and Hume 1970, Ishkhanian and Ramsey 1977, Isono et al 1987, Have1 et al 1989, Kelman et al 1990, Healy 1991, Motohashi et al 1991, Ochi et al 1995, but the natural history and best treatment are still unknown. In our study, lateral condyles tended to be affected and both condyles were mainly involved, as Chancelier et al (1992) claimed, in steroid-related osteonecrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Since 2 patients were reported by Dubois and Cozen (1960) in a series of 400 cases of systemic lupus erythematosus, steroid-or alcohol-related osteonecrosis of the femoral condyle has been sporadically reported (Isono et al 1987, Bohn et al 1989, Have1 et al 1989, Kelman et al 1990, Motohashi et al 1991, Ochi et al 1995. Condyles with minimum clinical symptoms may progress to collapse and generate osteocartilaginous fragments (Hall andHume 1970, Ishkhanian andRamsey 1977), needing surgical treatment.…”

mentioning

confidence: 99%

MRI evaluation of steroid- or alcohol-related osteonecrosis of the femoral condyle

Sakai

Sugano

Ohzono

et al. 1998

Acta Orthopaedica Scandinavica

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“…Este quadro foi inicialmente descrito em 1960 por Dubois e Cozen (22) , com prevalência estimada de apenas 5%. Estudos mais recentes têm documentado prevalências variando de 14% a 40%, provavelmente resultantes de melhores métodos diagnósticos (23) .…”

Section: Discussionunclassified

Contribuição da doença e sua terapêutica no índice de dano SLICC/ACR na fase precoce do lúpus eritematoso sistêmico

Bezerra¹,

Júnior²,

Borba³

et al. 2004

Rev. Bras. Reumatol.

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A maioria das informações relativas ao curso da doença de pacientes com lúpus eritematoso sistêmico (LES) é restrita aos primeiros cinco anos após o diagnóstico. Entretanto, dados sobre a precocidade de instalação dos danos são pouco descritos. Objetivo: identificar os danos precoces de pacientes com LES de diagnóstico recente e verificar a influência da própria doença ou de sua terapêutica como principal causa para a instalação destes danos. Métodos: foram estudados retrospectivamente 82 pacientes com LES, cujo diagnóstico foi realizado de 1998 até 1999 em nosso serviço. Em todos os pacientes o escore do índice de dano do Systemic Lupus Internacional Collaborating Clinics/American College of Rheumatology-Damage Index (SLICC/ACR-DI) foi avaliado no momento do diagnóstico e anualmente três vezes consecutivas. As manifestações clínicas e o esquema terapêutico foram avaliados nas consultas médicas. O escore do SLICC/ACR para cada órgão/sistema e a prevalência dos danos foi identificado, assim como a sua possível causa (doença ou terapia). Resultados: A idade (média) inicial foi de 31,6 anos com predomínio do sexo feminino (94%). A maioria dos pacientes (94%) apresentou manifestações cutâneas e articulares, seguidas pelas renais (40%), pulmonares (28%) e neurológicas (18%). Ao final do estudo, 52 pacientes (63,4%) não apresentaram seqüelas (sem pontuação no SLICC). Dos 30 pacientes restantes, 16 tiveram escore = 1 e 14 pacientes apresentaram escore = 2. No total observamos 36 danos, sendo 23 atribuídos à doença e 13 à terapia (64% vs 36%, p < 0,05). Os sistemas mais freqüentemente acometidos foram o articular e o neurológico (27,7%), seguidos pelo renal (13,8%). Todos os pacientes com comprometimento neurológico tiveram danos precoces decorrentes da própria doença (apesar da terapêutica agressiva) enquanto a terapêutica com corticóide foi responsável pelos danos em 7/10 pacientes com dano articular

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Avascular (Aseptic) Bone Necrosis Associated with Systemic Lupus Erythematosus

Cited by 207 publications

References 5 publications

Damage in systemic lupus erythematosus and its association with corticosteroids

Damage in systemic lupus erythematosus and its association with corticosteroids

MRI evaluation of steroid- or alcohol-related osteonecrosis of the femoral condyle

Contribuição da doença e sua terapêutica no índice de dano SLICC/ACR na fase precoce do lúpus eritematoso sistêmico

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