Osteonecrose em pacientes com lúpus eritematoso sistêmico

Abstract

Osteonecrosis is a relatively common complication in systemiclupus erythematosus (SLE) patients. Objective: To evaluate the possible risk factors associated with osteonecrosis in SLE patients. Methods: SLE patients [according to American College of Rheumatology (ACR) criteria] who presented osteonecrosis were included in this study. SLE patients with no symptomatic osteonecrosis constituted the control group. Osteonecrosis was confirmed by radiographic evaluation, bone scintigraphy and/or magnetic resonance imaging. Results: The study group was constituted by 14 SLE patients with osteonecrosis (10 women and 4 men, 64% of them white, 33±13 years old and 120±67 months of disease duration). Sex and time of SLE diagnosis matched patients without osteonecrosis constituted the control group (n=14, 57% of them white, 33±7 years old and 111±54 months of SLE). Systemic lupus international collaborating clinics/ACR damage index for SLE (SLICC/ACR-DI) score was higher in patients with osteonecrosis (4±1) compared with control group (1±1) [p<0.001]. Patients with osteonecrosis had higher number of other musculoskeletal irreversible damage when compared with the control group (29% versus 0, respectively; p=0.034). Digital vasculitis was the variable associated with osteonecrosis (p=0.021). There was no significant association between duration of prednisone use or prednisone cumulative dose and osteonecrosis in patients with regular follow-up at the Institution (p=0.624 and p = 0.806, respectively). Conclusions: Previous history of digital vasculitis was a risk factor for the development of osteonecrosis. Patients with digital vasculitis history had 9 times more risk to present osteonecrosis than patients without previous vasculitis

Life expectancy and death pattern associated with systemic lupus erythematosus diagnosis in Brazil between 2000 and 2019

“…15 In fact, cardiac involvement in SLE has been described between 50% and 89% in several studies throughout the course of the disease, with pericarditis being the most common manifestation. 16…”

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“…On the other hand, there are numerous publications showing the occurrence of iatrogenic events that can be classified as accidental and do not imply poor medical practice. 5 Examples of this situation would be the drug-induced rheumatic manifestations, 6,18,19 steroid-induced osteonecrosis, 20 drug-induced lupus-like syndromes, 21,22 cutaneous drug reactions, 23 side effects of drugs used in rheumatic diseases 24 and steroid-induced osteoporosis. 25 In regard to cutaneous drug reactions and drug reactions in hospitalized patients, a meta-analysis 26 demonstrated a 6.7% incidence of severe reactions defined as those requiring hospitalization or associated with deaths.…”

Osteonecrose da cabeça femoral: Artigo de atualização

“…Outras patologias menos comuns, 14 15 16 17 18 19 como doença de Gaucher, doença de Caisson, disbarismo por mergulhos em águas profundas, assim como HIV, radioterapia, gravidez, tabagismo e gota também podem levar a ONCF. Um estudo recente demonstrou que, em casos idiopáticos, alterações acetabulares com menor cobertura da cabeça femoral podem estar relacionadas à ONCF.…”

“…Other less common pathologies, 14 15 16 17 18 19 such as Gaucher disease, Caisson disease, dysbarism from deep water diving, as well as HIV, radiation therapy, pregnancy, smoking and gout can also lead to ONFH. A current study has shown that, in idiopathic cases, acetabular alterations with less coverage of the femoral head may be related to ONFH.…”