Multifocal avascular osteonecrosis despite appropriate anticoagulation therapy in a patient with systemic lupus erythematosus and antiphospholipid syndrome

Cecchi, Irene; Sánchez, Laura Pérez; Sciascia, Savino; Roccatello, Dario

doi:10.1136/bcr-2018-225532

Cited by 4 publications

(4 citation statements)

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“…29 Two case reports described potential correlations between aPLs and a rare multifocal ON. [33][34][35] The hypercoagulable state of blood and formation of vascular thrombus related to aPLs were suggested as the underlying pathological mechanisms. 14,15 We therefore speculate that patients with aPLs are more likely to develop multiple osteonecrosis, and the use of large doses of GC may promote this process.…”

Section: Discussionmentioning

confidence: 99%

Risk of osteonecrosis in systemic lupus erythematosus: An 11-year Chinese single-center cohort study

Long

Zhang

You

et al. 2021

Lupus

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Objective Osteonecrosis (ON), which can lead to physical disability, is a common complication of systemic lupus erythematosus (SLE). The purpose of this study was to determine the prevalence of ON and identify possible risk factors in Chinese SLE patients. Methods SLE patients who fulfilled the 1997 American College of Rheumatology SLE classification criteria were recruited from the Peking Union Medical College Hospital. The chi-square test (χ 2 test) and multivariate regression analyses were used to evaluate risk factors. The Cox proportional-hazards model was used to construct the survival curves and estimate the simultaneous effects of prognostic factors on survival. Results We consecutively enrolled 1,158 patients, of which 88 patients (7.6%) developed ON. Among ON patients, 57.1% of patients had isolated femoral head necrosis and 42.9% had multiple joint involvement. The mean age of ON patients (24.62 ± 8.89 years) was significantly younger than SLE patients without ON (27.23 ± 10.16 years, p = 0.09). The ON group presented with a much longer disease course (10.68 ± 5.97 years, p < 0.001) and increased incidence of arthritis, kidney, and central nervous system (CNS) involvement (65.9% [ p < 0.05], 57.6% [ p < 0.05], and 16.5% [ p < 0.05], respectively, in the ON group). ON patients were more likely to be treated with glucocorticoid (GC) and to receive a high dose of prednisolone at the initial stage of SLE ( p < 0.05). The percentage of patients who received hydroxychloroquine was much higher in the control group ( p < 0.001). Cox regression analysis suggested that CNS involvement and GC therapy were two independent risk factors for ON in SLE patients. The presence of anti-phospholipid antibodies (aPLs) was a risk factor for multiple joint necrosis (odds ratio: 6.28, p = 0.009). Conclusions ON remains a serious and irreversible complication in SLE. In addition to glucocorticoid therapy, we found that CNS system involvement was a risk factor for ON, while the administration of hydroxychloroquine was a protective factor. The clinical characteristics of multiple site ON patients were distinct from isolated femoral head necrosis patients. The presence of aPLs was a risk factor for multiple site osteonecrosis.

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Section: Discussionmentioning

confidence: 99%

Risk of osteonecrosis in systemic lupus erythematosus: An 11-year Chinese single-center cohort study

Long

Zhang

You

et al. 2021

Lupus

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“…Most are case reports or series [ 27 – 30 ]. While these reports describe multifocal ON in patients with SLE [ 28 ], HIV [ 30 ], leukemia [ 29 ], and lymphoma [ 27 ], they do not address whether or to what extent these comorbidities individually pose a risk for multifocal ON. In one prospective study of 170 patients with ALL and ON, 85% had multifocal ON [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have investigated the relationship between underlying condition and extent of disease in patients with glucocorticoid-induced ON. Most are case reports or series [27][28][29][30]. While these reports describe multifocal ON in patients with SLE [28], HIV [30], leukemia [29], and lymphoma [27], they do not address whether or to what extent these comorbidities individually pose a risk for multifocal ON.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for multi-joint disease in patients with glucocorticoid-induced osteonecrosis

et al. 2021

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Summary This study investigated risk factors for osteonecrosis involving multiple joints (MJON) among glucocorticoid-treated patients. The best predictor of MJON was cumulative oral glucocorticoid dose. Risk of MJON was 12-fold higher in patients who had a second risk factor for osteonecrosis. Further research is needed into strategies for prevention of MJON. Introduction Osteonecrosis (ON) is a debilitating musculoskeletal condition in which bone cell death can lead to mechanical failure. When multiple joints are affected, pain and disability are compounded. Glucocorticoid treatment is one of the most common predisposing factors for ON. This study investigated risk factors for ON involving multiple joints (MJON) among glucocorticoid-treated patients. Methods Fifty-five adults with glucocorticoid-induced ON were prospectively enrolled. MJON was defined as ON in ≥ three joints. Route, dose, duration, and timing of glucocorticoid treatment were assessed. Results Mean age of enrolled subjects was 44 years, 58% were women. Half had underlying conditions associated with increased ON risk: systemic lupus erythematosus (29%), acute lymphoblastic leukemia (11%), HIV (9%), and alcohol use (4%). Mean daily oral dose of glucocorticoids was 29 mg. Average cumulative oral dose was 30 g over 5 years. The best predictor of MJON was cumulative oral glucocorticoid dose. For each increase of 1,000 mg, risk of MJON increased by 3.2% (95% CI 1.03, 1.67). Glucocorticoid exposure in the first 6 months of therapy, peak dose (oral or IV), and mean daily dose did not independently increase risk of MJON. The risk of MJON was 12-fold in patients who had a second risk factor (95% CI 3.2, 44.4). Conclusions Among patients with glucocorticoid-induced ON, cumulative oral dose was the best predictor of multi-joint disease; initial doses of IV and oral glucocorticoids did not independently increase risk. Further research is needed to better define optimal strategies for prevention and treatment of MJON.

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“…Имеются данные о развитии ОН у пациентов с первичным антифосфолипидным синдромом, не получавших ГК [52], и у пациентов с мультифокальным ОН на фоне гиперпродукции антифосфолипидных антител (аФЛ) и других нарушений, ассоциирующихся с развитием тромбофилии [53][54][55][56]. Это свидетельствует о потенциальном значении аФЛ, индуцирующих развитие микротромбозов сосудов, кровоснабжающих головку бедренной кости, в генезе этой патологии.…”

Section: Hip Arthroplasty In Patients With Systemic Lupus Erythematosusunclassified

Hip Arthroplasty in Patients With Systemic Lupus Erythematosus

Mukhanov

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et al. 2020

Naučno-praktičeskaâ revmatologiâ

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Multifocal avascular osteonecrosis despite appropriate anticoagulation therapy in a patient with systemic lupus erythematosus and antiphospholipid syndrome

Cited by 4 publications

References 10 publications

Risk of osteonecrosis in systemic lupus erythematosus: An 11-year Chinese single-center cohort study

Risk of osteonecrosis in systemic lupus erythematosus: An 11-year Chinese single-center cohort study

Risk factors for multi-joint disease in patients with glucocorticoid-induced osteonecrosis

Hip Arthroplasty in Patients With Systemic Lupus Erythematosus

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