Osteonecrosis in Systemic Lupus Erythematosus

Gontero, Romina Patricia; Bedoya, María Eugenia; Benavente, Emilio; Roverano, Susana; Paira, Sergio

doi:10.1016/j.reumae.2014.05.006

Cited by 15 publications

(19 citation statements)

References 11 publications

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“…Osteonecrosis was associated with Cushing’s syndrome and accumulated damage at year 2. 9 A study from Korea including 25,358 patients with SLE reported that the prevalence of osteonecrosis between 2006 and 2010 was 31.5–34.2 per 1000 persons. A standardized annual incidence rate of 7.6–9.2 per 1000 was calculated between 2008 and 2010.…”

Section: Discussionmentioning

confidence: 99%

“…Strategies to minimize glucocorticosteroid use are necessary to prevent this serious complication. 8 744 13% GCS Gontero et al 9 158 9.5% Cushing's syndrome and SDI at 2 years Joo et al 10 25,358 3.3% GCS, IS, antimalarial, lipid-lowering agents Lee et al 11 1051 6.9% Cushingoid habitus, use of cyclophosphamide and azathioprine Kunyakham et al 12 736 8.8% Haematological involvement, longer disease duration Sayarlioglu et al 13 868 6% Not done Al Saleh et al 14…”

Section: Discussionmentioning

confidence: 99%

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Osteonecrosis in SLE: prevalence, patterns, outcomes and predictors

Gladman

Dhillon

et al. 2017

Lupus

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Objective Osteonecrosis is a serious comorbidity in patients with systemic lupus erythematosus. The aims of this study were to describe the prevalence of symptomatic osteonecrosis, determine the pattern of joint involvement, identify the outcomes and investigate predictive factors in a large cohort of patients with systemic lupus erythematosus followed prospectively. Methods At the Toronto Lupus Clinic patients have been followed prospectively according to a standard protocol since 1970. Osteonecrosis is recorded if patients are symptomatic and is confirmed by imaging. The site of osteonecrosis is recorded and whether or not surgery was performed. For determination of prevalence, pattern and outcome of osteonecrosis a longitudinal cohort design was performed. For the predictive factors, only patients with incident osteonecrosis were included and were matched for gender, year of entry to clinic (within 5 years), year of birth (within 5 years) and disease duration (within 3 years) with systemic lupus erythematosus patients without osteonecrosis. Results Of 1729 patients with systemic lupus erythematosus registered in the database, 234 (13.5%) developed symptomatic osteonecrosis in 581 sites. Hips and knees were most commonly affected and 47% of the patients had multiple sites involved. More than half of the joints involved at first occurrence of osteonecrosis had surgery. Univariate analysis identified black race, damage, elevated cholesterol and glucocorticosteroids as predictive factors, but glucocorticosteroids remained as the primary predictor for the development of osteonecrosis on multivariable analysis. Conclusion Despite advancements in the assessment and treatment of systemic lupus erythematosus, symptomatic osteonecrosis continues to be a significant comorbidity. Strategies to minimize glucocorticosteroid use are necessary to prevent this serious complication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Osteonecrosis in SLE: prevalence, patterns, outcomes and predictors

Gladman

Dhillon

et al. 2017

Lupus

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“…MERGE promotes tissue contrast due to a high signal‐to‐noise ratio and spatial resolution along with a low susceptibility to artifacts. Therefore, this study fit T 1 ρ and T 2 mapping data with MERGE data to improve the spatial resolution and tissue contrast, reduce chemical shift artifacts and image distortion, and obtain higher‐quality T 1 ρ and T 2 mapping . The patients were required to undergo MRI during a fixed period (20:00–23:00) and remain seated for half an hour before the MRI to reduce the mechanical effects on T 2 mapping.…”

Section: Methodsmentioning

confidence: 99%

“…with 5‐year experience and were independently verified by two coauthors, P.S. and X.M.L., with 8 and 10 years experience, respectively, from the Radiology Department based on the ARCO staging (Phase I: the radiograph in anteroposterior position was unremarkable, while the lesion was excited by MRI; Phase II: positive X‐ray without collapse of the femoral head or acetabular abnormalities; and Phase III: subclassification depended on the extent of the crescent, and the radiographic findings included subchondral lucency and subchondral collapse). The reviewers consulted with each other if any inconsistent opinions existed.…”

Section: Methodsmentioning

confidence: 99%

T₁ρ and T₂ mapping for the determination of articular cartilage denaturalization with osteonecrosis of the femoral head: A prospective controlled trial

Han

Hong

Chen

et al. 2018

Magnetic Resonance Imaging

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Background In the future, biochemical MRI might provide a valuable noninvasive quantitative analysis of the biochemical composition of cartilage in osteonecrosis of the femoral head (ONFH). Purpose To investigate the diagnostic performance of T1ρ and T2 mapping in cartilage denaturalization with ONFH and to determine the correlation between T1ρ and T2 mapping and the Association Research Circulation Osseous (ARCO) stage. Study Type Prospective. Subjects Forty‐seven patients with ONFH (stage I to III according to the ARCO criteria) and 24 volunteers (control group) were recruited for the prospective study. Sequence Conventional MRI, multiple echo recalled gradient echo (MERGE), and T1ρ and T2 mapping sequences. Assessment Pseudocolor images and MERGE images were combined in the AW4.5 workstation. The region of interest (ROI) of the hip cartilage was 4–6 mm². The sagittal T1ρ and T2 mapping values were calculated by the two first authors. Statistical Tests One‐way analysis of variance (ANOVA), LSD t‐tests, Pearson correlation analysis, and receiver operator characteristic (ROC) curves. The significance level was set at P < 0.05. Results The T1ρ and T2 mapping values of the ONFH group were significantly higher than the values of the control group (P = 0.000). Regarding the assessment of the severity of ARCO staging, both T1ρ (r = 0.66, P = 0.004) and T2 mapping (r = 0.501, P = 0.002) were positively associated with disease severity. The T1ρ values were positively correlated with the T2 mapping values (r = 0.381, P = 0.000). The areas under the curve (AUC) for the T1ρ and T2 mapping values were 0.822 and 0.791, respectively. The diagnostic sensitivity and specificity were 72.34% and 70.83% for T1ρ mapping and 72.34% and 58.33%, respectively, for T2 mapping. Data Conclusion Both T1ρ and T2 mapping performed well in diagnosing the cartilage denaturalization in ARCO stage I‐III ONFH patients. T1ρ mapping had a higher diagnostic sensitivity and specificity than T2 mapping. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:760–767.

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“…The musculoskeletal pain manifestation of SLE is diverse including arthralgia, synovitis, myositis, myopathy and AVN of bone which occurs in variable frequencies at various stages of the disease. 4,5 The Systemic Lupus International Collaborating Clinics (SLICC) group revised and validated the American College of Rheumatology (ACR) SLE classification criteria to improve clinical relevance, meet stringent methodology requirements and incorporate new knowledge regarding the immunology of SLE. 5 Antiphospholipid syndrome (APS), also known as 'Hughes Syndrome,' is an autoimmune hypercoagulability disorder characterized by arterial and venous thrombosis and recurrent pregnancy losses in patients with antiphospholipid antibodies (aPL).…”

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confidence: 99%

Bone Infarctions in a Patient with Systemic Lupus Erythematosus and Anti-phospholipid Syndrome

Ordahan¹,

Karahan²

2018

J PMR Sci

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Osteonecrosis in Systemic Lupus Erythematosus

Cited by 15 publications

References 11 publications

Osteonecrosis in SLE: prevalence, patterns, outcomes and predictors

Osteonecrosis in SLE: prevalence, patterns, outcomes and predictors

T₁ρ and T₂ mapping for the determination of articular cartilage denaturalization with osteonecrosis of the femoral head: A prospective controlled trial

Bone Infarctions in a Patient with Systemic Lupus Erythematosus and Anti-phospholipid Syndrome

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Osteonecrosis in Systemic Lupus Erythematosus

Cited by 15 publications

References 11 publications

Osteonecrosis in SLE: prevalence, patterns, outcomes and predictors

Osteonecrosis in SLE: prevalence, patterns, outcomes and predictors

T1ρ and T2 mapping for the determination of articular cartilage denaturalization with osteonecrosis of the femoral head: A prospective controlled trial

Bone Infarctions in a Patient with Systemic Lupus Erythematosus and Anti-phospholipid Syndrome

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T₁ρ and T₂ mapping for the determination of articular cartilage denaturalization with osteonecrosis of the femoral head: A prospective controlled trial