Disease activity as a major risk factor for osteonecrosis in early systemic lupus erythematosus

Abstract

This study Identifies the possible risk factors for osteonecrosis (ON) in a homogenous group of early system lupus erythematosus (SLE). Forty-six consecutive SLE patients (<5 years duration) followed at the Lupus Clinic, were enrolled between 2004 and 2005. An extensive clinical and laboratory evaluation using a standard electronic protocol established since 1999, including osteonecrosis symptoms and appropriate magnetic resonance imaging (MRI), were carried out at 1-6 months intervals. All other asymptomatic for osteonecrosis patients at study entry underwent MRI. ON confirmed by MRI was found in 10 of 46 patients (22%). Age, disease duration, clinical vascular features, frequency of thrombophilia and hypofibrinolysis factors and the lipoprotein profile were comparable in patients with and without osteonecrosis (P > 0.05). Remarkably, the frequency of patients with system lupus erythematosus disease activity index (SLEDAI) > or =8 in the previous year of osteonecrosis clinical diagnosis was significantly higher when compared to patients without this manifestation (60.0% versus 19.4%, P = 0.011), supported by the higher glucocorticoid cumulative dose in the same period (P = 0.045). In contrast, these two parameters evaluated in 13th-24th months preceding osteonecrosis diagnosis were similar in patients with and without osteonecrosis (P > 0.05). In the logistic regression analysis only SLEDAI remained as an independent risk factor for ON (OR = 6.78, CI = 1.05-43.55, P = 0.04). Disease activity in the previous year of ON clinical diagnosis is the main predictor factor for the development of this complication in early SLE.

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

“…We believe that the lack of correlation between the lipid profile and ON in our patients is due to the protective effect of hydroxychloroquine, which was used by all of the patients. Supporting the importance of disease activity as a main predictor of the development of ON in SLE, Fialho et al [27] used MRI to study 46 SLE patients over a 6 month period and found that at the end of the observation period an SLEDAI >8 was significantly more prevalent in those initially diagnosed with ON than in those without this manifestation (60% vs 19.4%) [27]. We found no correlation between disease activity and ON.…”

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

“…One study 27 61 , and it did not find a statistically significant association. Risk factors related to laboratory results.…”

Multifocal osteonecrosis in systemic lupus erythematosus: case report and review of the literature

“…Pleural effusion, nephritis, anaemia, Raynaud's phenomenon, arthritis, myositis, antiphospholipid antibodies, anti-Ro and anti-RNP antibodies and exposure to CS and cytotoxic agents have been associated with ON 3 – 5. Moreover, disease activity has been reported as the main risk factor for ON 20. Hence, based on the current literature review, the clinical manifestations associated with multifocal ON appear to be similar to those with non-multifocal involvement.…”

“…In a case–control study in SLE patients, Prasad et al 5 found that CS use was the major factor linked with the development of ON. The duration of corticosteroid therapy, total cumulative dose and highest daily dose have been independently associated with the development of ON 3 20. CS may induce ON by increasing the amount of fat within the bone, elevating the intramedullar pressure and consequently producing sinusoidal collapse.…”