The Risk Factors of Avascular Necrosis in Patients with Systemic Lupus Erythematosus: a Meta-analysis

Abstract

The aim of this study was to determine the risk factors for avascular necrosis (AVN) in patients with systemic lupus erythematosus (SLE). Four electronic databases (PubMed, EMBASE, Ovid, and Science Direct) were searched for. The search was performed to identify the articles as to SLE with AVN before September 2013. The clinical and laboratory data were extracted, and a meta-analysis was performed to identify the risk factors for AVN in patients with SLE. Publication bias was assessed with funnel plot and Egger's test. A total of 995 papers were found from the four databases; 16 studies were finally included. Pooled analysis showed the following result. The result showed that arthritis (odds ratio (OR)=2.448, 95 % confidence interval (CI)=1.617-3.707), cushingoid (OR=3.890, 95 % CI=1.591-9.510), gastrointestinal involvement (OR=2.054, 95 % CI=1.283-3.290), hypertension (OR=1.482, 95 % CI=1.093-2.008), oral ulcers (OR=1.877, 95 % CI=1.182-2.979), pleuritis (OR=2.302, 95 % CI=1.325-4.001), renal disease (OR=1.475, 95 % CI=1.124-1.936), and vasculitis (OR=2.591, 95 % CI=1.358-4.944) were relevant with AVN in SLE patients. Cytotoxic drug (OR=1.834, 95 % CI=1.065-3.156, P=0.029), the total cumulative dose (Standard Mean Difference (SMD) = 1.104, 95 % CI = 0.118-2.090, P = 0.028), maximum daily dose (SMD = 0.484, 95 % CI = 0.288-0.678, P < 0.001), and mean daily dose (SMD=1.305, 95 % CI=0.061-2.549, P=0.040) were significantly higher in AVN group. There were no significantly laboratory features that appeared in this pooled analysis. We conclude that arthritic, cushingoid, gastrointestinal involvement, hypertension, oral ulcers, pleuritis, renal disease, vasculitis, cytotoxic drug, and steroid treatment may contribute to AVN in SLE patients.

Cardiac Manifestations in Systemic Lupus Erythematosus: Clinical Correlates of Subclinical Echocardiographic Features

“…In agreement with that, proteinuria has recently been reported to be a predictor of pericarditis [30]. The risk of AVN with renal disease and hypertension was previously established [31], and it is noticed in the current work that AVN is a predictor of pericardial effusion as well. In this context, the protective effect of HCQ against metabolic disorders in SLE [32, 33] seems to modify the risk of pericardial diseases.…”

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

“…Another one 70 did not find a strong correlation between aPL and the occurrence of ON. Thus, the true character of the association between aPL and ON in SLE is not clear and seems to be, at best, weak.…”

Temporal course of avascular femoral head necrosis in patients with pemphigus vulgaris

“…The additive effects of multidrug treatment in PV patients should not be underestimated. Not only do corticosteroids have a significantly deleterious impact on bone metabolism, many studies have also found cytotoxic drugs to be risk factors for AVN . Bisphosphonate‐induced vitamin D deficiency may also contribute to the occurrence of AVN, as reported in ONJ and pediatric AVN cases .…”