Risk of osteonecrosis in systemic lupus erythematosus: An 11-year Chinese single-center cohort study. (August 2021)

• Record Type: Journal Article
• Authors: Long, Yin; Zhang, Shangzhu; Zhao, Jiuliang; You, Hanxiao; Zhang, Li; Li, Jing; Leng, Xiaomei; Wang, Qian; Tian, Xinping; Li, Mengtao; Zeng, Xiaofeng
• Is Part Of: Lupus. Volume 30:Number 9(2021)
• Page Start: 1459
• Page End: 1468
• Publication Date: 2021-08
• Subjects: Systemic lupus erythematosus -- osteonecrosis -- anti-phospholipid antibodies -- risk factors; Systemic lupus erythematosus -- Periodicals; 616.772005
• DOI: 10.1177/09612033211021166
• Languages: English
• ISSNs: 0961-2033

Abstract

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.