High triglyceride is a risk factor for silent osteonecrosis of the femoral head in systemic lupus erythematosus

Abstract

The purpose of this study was to clarify the factors related to silent osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE). Seventy-eight patients with SLE were selected on the basis of having been newly diagnosed and requiring high-dose prednisolone, including pulse therapy with methylprednisolone, as the initial treatment. All the patients initially underwent MRI at 3 months after the start of corticosteroid treatment to detect any early changes in the femoral head. These examinations were then performed again 3 months later. Laboratory parameters were evaluated at the start of steroid treatment and at 1 month thereafter. By 3 months after the start of corticosteroid treatment, silent ONFH was diagnosed by MRI in 21 patients (26.9 %), being bilateral in 11 patients and unilateral in 10. The occurrence of silent ONFH was not related to SLE disease activity index, serological activity, or renal function; it was also unrelated to body mass index (BMI), body surface area (BSA), and the initial dose of prednisolone per unit body weight. However, the total cholesterol level at 4 weeks after the start of steroid treatment tended to be higher in patients with silent ONFH. Patients with a higher triglyceride level showed a significantly higher frequency of silent ONFH both before (p = 0.002) and 4 weeks after (p = 0.036) steroid initiation.A high triglyceride level is an important risk factor for silent ONFH in patients with SLE, and large-scale epidemiologic surveys of such early events are needed in this patient population.

Idiopathic Osteonecrosis and Atypical Femoral Fracture in Systemic Lupus Erythematosus

“…A Japanese nationwide study revealed that cigarete smoking was an independent risk factor for ION [42]. However, in our present study, cigarete smoking was not correlated with ION in SLE patients [32].…”

“…However, these factors were not correlated with ION. Thus, both initial serological disease activity and initial renal function, as the most common forms of organ involvement, did not appear to be correlated with ION [32]. Similar results were obtained in a previous single-center study [23].…”

“…However, the link between APS antibodies and ION is controversial [38][39][40][41]. In our study, there was no signiicant association between APS antibody and ION [32]. A Japanese nationwide study revealed that cigarete smoking was an independent risk factor for ION [42].…”

“…TC levels tended to be higher than that in the non-ION group, and the maximum levels and increasing rates were signiicantly higher, suggesting that a rapid rise in serum lipids soon after an increase in glucocorticoid dose might afect the onset of ION [23]. Our data suggested that the level of TG both before and after the initiation of steroid therapy was higher in patients with ION [32]. The TG level before PSL therapy was associated future risk of asymptomatic ION.…”

“…This would allow better clariication of the background factors associated with ION. On the basis of this concept, we investigated the early development of ION in a cohort of strictly selected SLE patients using MRI and the early changes in laboratory parameters associated with steroid therapy [32].…”