Risk factors for avascular bone necrosis in systemic lupus erythematosus

Mok, Chi Chiu; Lau, Chak-Sing; Wong, Raymond Woon Sing

doi:10.1093/rheumatology/37.8.895

Cited by 135 publications

(147 citation statements)

References 10 publications

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“…Other potential risk factors include vasculitis and Raynaud's phenomenon (12). We and other investigators have previously reported that high-dose prednisone, rather than the total cumulative dose, is an important predictor of AVN (25)(26)(27)(28)(29)(30)(31). While one study has reported that pulse methylprednisolone increases the risk of AVN in SLE, this remains a subject of controversy (27).…”

Section: Discussionmentioning

confidence: 99%

Damage in systemic lupus erythematosus and its association with corticosteroids

Zonana-Nacach

Barr

Magder

et al. 2000

Arthritis & Rheumatism

440

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: 99%

Damage in systemic lupus erythematosus and its association with corticosteroids

Zonana-Nacach

Barr

Magder

et al. 2000

Arthritis & Rheumatism

440

244

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“…The Journal of on April 27, 2019 -Published by www.jrheum.org Downloaded from the use of high-dose CS early in the course of SLE, especially in patients who develop Cushingoid appearance 1,17,32,40,54,65 . However, 1 study of 144 patients followed by periodic MRI (hips and knees) for a minimum of 10 years found no new lesion development in patients receiving a low or medium CS dose (< 30 mg/day of prednisone) 34 .…”

Section: Rheumatologymentioning

confidence: 99%

“…In fact, some authors found that immunosuppressive therapy is a risk factor for ON 17,22,30,32,42,57 . Conversely, these agents could be surrogates for disease activity, which could be a risk for ON.…”

Section: Rheumatologymentioning

confidence: 99%

Monitoring of Osteonecrosis in Systemic Lupus Erythematosus: A Systematic Review and Metaanalysis

et al. 2018

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Objective.Nontraumatic osteonecrosis (ON) is a well-recognized complication causing disability and affecting quality of life in patients with systemic lupus erythematosus (SLE). The aim of this study was to identify the risk factors for ON, and to identify the minimal investigation(s) needed to optimally monitor the risk of ON in patients with SLE.Methods.A systematic review was conducted using MEDLINE and EMBASE. These databases were searched up to January 2016 using the Medical Subject Heading (MeSH) terms “Osteonecrosis,” “Systemic lupus erythematosus,” and synonymous text words. Randomized controlled trials, case control, cohort, and cross-sectional studies were included. Risk factors for ON in patients with SLE were compiled. The quality of each study was assessed using the Newcastle-Ottawa scale for nonrandomized studies. The quality of evidence of each risk factor was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation method.Results.Of the 545 references yielded, 50 met inclusion criteria. Corticosteroid (CS) use may be strongly associated with ON in patients with SLE. Other clinical variables were moderately associated, including hypertension, serositis, renal disease, vasculitis, arthritis, and central nervous system disease. However, the evidence was low to very low in quality.Conclusion.Based on the best evidence available, CS use may be strongly associated with ON in patients with SLE. Results of this review were considered in the development of recommendations for the diagnosis and monitoring of patients with SLE in Canada and will guide clinicians in their assessment of these patients.

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“…Houssiau et al [24], in their report of a study of ON in SLE patients, stated that the prevalence of ON in SLE did not correlate with aCL; others have found a positive relationship with the presence of lupus anticoagulant [25,26], or between ON and IgG aCL in caucasian patients [23]. In all of these studies, the patients had received GC, which is the major predisposing factor for ON.…”

Section: Mri For Detecting Osteonecrosis In Juvenile Systemic Lupus Ementioning

confidence: 99%

The use of joint-specific and whole-body MRI in osteonecrosis: a study in patients with juvenile systemic lupus erythematosus

Castro¹,

Lederman²,

Terreri³

et al. 2011

BJR

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Objective: This study aimed to estimate the prevalence of osteonecrosis (ON) in juvenile systemic lupus erythematosus (SLE) patients using joint-specific and wholebody MRI; to explore risk factors that are associated with the development of ON; and to evaluate prospectively patients 1 year after initial imaging. Method: Within a 2 year period, we studied 40 juvenile SLE patients (aged 8-18 years) with a history of steroid use of more than 3 months duration. Risk factors including disease activity, corticosteroid use, vasculitis, Raynaud's phenomenon and lipid profile were evaluated. All patients underwent MRI of the hips, knees and ankles using jointspecific MRI. Whole-body STIR (short tau inversion recovery) MRI was performed in all patients with ON lesions. Results: Osteonecrosis was identified in 7 patients (17.5 %) upon joint-specific MRI. Whole-body STIR MRI detected ON in 6 of these 7 patients. There was no significant difference between the ON and non-ON groups in the risk factors studied. One patient had pre-existing symptomatic ON. At 1 year follow-up, the ON lesions had resolved in one patient, remained stable in four and decreased in size in two. No asymptomatic patients with ON developed clinical manifestations. Conclusion: Whole-body STIR MRI may be useful in detecting ON lesions in juvenile SLE patients but larger studies are needed to define its role.

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Risk factors for avascular bone necrosis in systemic lupus erythematosus

Cited by 135 publications

References 10 publications

Damage in systemic lupus erythematosus and its association with corticosteroids

Damage in systemic lupus erythematosus and its association with corticosteroids

Monitoring of Osteonecrosis in Systemic Lupus Erythematosus: A Systematic Review and Metaanalysis

The use of joint-specific and whole-body MRI in osteonecrosis: a study in patients with juvenile systemic lupus erythematosus

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