Avascular necrosis less frequently found in systemic lupus erythematosus patients with the use of alternate day corticosteroid
Avascular necrosis less frequently found in systemic lupus erythematosus patients with the use of alternate day corticosteroid
Background/aim: Avascular necrosis (AVN) is the death of bone due to compromise of blood flow. The etiology of AVN is multifactorial;corticosteroid usage is the second most significant factor after trauma, and systemic lupus erythematosus (SLE) is the most commonunderlying disease. The objective of this study was to assess the factors of AVN in SLE patients.Materials and methods: The study included 127 patients with SLE who fulfilled 1997 American College of Rheumatology (ACR) revisedcriteria. Demographic data, age at SLE diagnosis, disease duration, disease activity, body mass index, clinical findings, antiphospholipidsyndrome, steroid usage, dose and duration, comorbid diseases, and smoking history were recorded.Results: AVN was found in 11 of 127 (8.7%) SLE patients. Hyperlipidemia (P < 0.001), cushingoid body habitus (P < 0.001), andproteinuria (P = 0.013) were found at higher rates in the AVN group. All of the 11 AVN cases had osteoporosis (P < 0.02). In multivariateregression analysis, daily steroid usage was the only factor for development of AVN in SLE.Conclusion: The hypothesis of our study was that an alternate day steroid regimen may decrease AVN frequency in SLE patients.
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- 1. Fukushima W, Fujioka M, Kubo T, Tamakoshi A, Nagai M et al.
Nationwide epidemiologic survey of idiopathic osteonecrosis
of the femoral head. Clinical Orthophedics and Related
Research 2010; 468: 2715-2724.
- 2. Dubois E, Cozen L. Avascular necrosis associated with lupus
erythematosus. Journal of the American Medical Association
1960; 174: 966-971.
- 3. Joo YB, Sung YK, Shim JS, Kim JH, Lee EK et al. Prevalence,
incidence, and associated factors of avascular necrosis in
Korean patients with systemic lupus erythematosus: A
nationwide epidemiologic study. Rheumatology International
2015; 35: 879-886.
- 4. Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld
Y, Gershwin ME. Pathogenesis and natural history of
osteonecrosis. Seminars in Arthritis and Rheumatism 2002;
32: 94-124.
- 5. Hochberg MC. Updating the American College of
Rheumatology revised criteria for the classification of systemic
lupus erythematosus. Arthritis & Rheumatology 1997; 40:
1725.
- 6. Brunner HI, Feldman BM, Bombardier C, Silverman ED.
Sensitivity of the Systemic Lupus Erythematosus Disease
Activity Index, British Isles Lupus Assessment Group Index, and
Systemic Lupus Activity Measure in the evaluation of clinical
change in childhood-onset systemic lupus erythematosus.
Arthritis & Rheumatology 1999; 42: 1354-1360.
- 7. Wilson WA, Gharavi AE, Koike T, Lockshin MD, Branch
DW et al. International consensus statement on preliminary
classification criteria for definite antiphospholipid syndrome:
report of an international workshop. Arthritis & Rheumatology
1999; 42: 1309-1311.
- 8. Sekiya F, Yamaji K, Yang K, Tsuda H, Takasaki Y. Investigation
of occurrence of osteonecrosis of the femoral head after
increasing corticosteroids in patients with recurring systemic
lupus erythematosus. Rheumatology International 2010; 30:
1587-1593.
- 9. Sagakuchi M, Tanaka T, Fukushima W, Kubo T, Hirota Y.
Impact of oral corticosteroid use for idiopathic osteonecrosis
of the femoral head: a nationwide multicenter case-control
study in Japan. Journal of Orthopedic Science 2010; 15: 185-
191.
- 10. Gladman DD, Dhillon N, Su J, Urowitz MB. Osteonecrosis
in SLE: prevalence, patterns, outcomes and predictors. Lupus
2018; 27 (1): 76-81. doi: 10.1177/0961203317711012
- 11. Sayarlioglu M, Yuzbsioglu N, Inanc M, Kamali S, Cefle A et al.
Risk factors for avascular bone necrosis in patients with systemic
lupus erythematosus. Rheumatology International 2012; 32:
177-182.
- 12. Heshin-Bekenstein M, Trupin L, Yelin E, von Scheven E,
Yazdany J et al. Longitudinal disease- and steroid-related
damage among adults with childhood-onset systemic lupus
erythematosus. Seminars in Arthritis and Rheumatism 2019;
49 (2): 267-272. doi: 10.1016/j.semarthrit.2019.05.010
- 13. Faezi ST, Hoseinian AS, Paragomi P, Akbarian M, Esfahanian
F et al. Non-corticosteroid risk factors of symptomatic
avascular necrosis of bone in systemic lupus erythematosus: A
retrospective case-control study. Modern Rheumatology 2015;
25 (4): 590-594. doi: 10.3109/14397595.2014.987366
- 14. Smith FE, Sweet DE, Brunner CM, Davis JS. Avascular
necrosis in SLE. An apparent predilection for young patients.
Annals of the Rheumatic Diseases 1976; 35: 227-232.
- 15. Cozen L, Wallace DJ. Avascular necrosis in systemic lupus
erythematosus: clinical associations and a 47-year perspective.
American Journal of Orthopedics 1998; 27: 352-354.
- 16. Wang GJ, Rawles JG, Hubbard SL, Stamp WG. Steroid-induced
femoral head pressure changes and their response to lipidclearing
agents. Clinical Orthophedics and Related Research
1983: 174; 298-302.
- 17. Kuroda T, Tanabe N, Wakamatsu A, Takai C, Sato H et al.
High triglyceride is a risk factor for silent osteonecrosis of
the femoral head in systemic lupus erythematosus. Clinical
Rheumatology 2015; 34 (12): 2071-2077. doi: 10.1007/s10067-
015-3075-y
- 18. Kerachian MA, Seguin C, Harvey EJ. Glucocorticoids in
osteonecrosis of the femoral head: A new understanding of
the mechanisms of action. Journal of Steroid Biochemistry &
Molecular Biology 2009: 114; 121-128.
- 19. Zhang K, Zheng Y, Jia J, Ding J, Wu Z. Systemic lupus
erythematosus patients with high disease activity are associated
with accelerated incidence of osteonecrosis: a systematic
review and meta-analysis. Clinical Rheumatology 2018; 37 (1):
5-11. doi: 10.1007/s10067-017-3820-5
- 20. Houssiau FA, N’Zeusseu Toukap A, Depresseux G, Maldague
BE, Malghem J et al. Magnetic resonance imaging-detected
avascular osteonecrosis in systemic lupus erythematosus:
lack of correlation with antiphospholipid antibodies. British
Journal of Rheumatology 1998; 37: 448-453.
- 21. Mok CC, Lau CS, Wong RW. Risk factors for avascular bone
necrosis in systemic lupus erythematosus. British Journal of
Rheumatology 1998; 37: 895-900.
- 22. Migliaresi S, Picillo U, Ambrosone L, Di Palma G, Mallozzi M et
al. Avascular necrosis in patients SLE: relation to corticosteroid
therapy and anticardiolipin antibodies. Lupus 1994; 3: 37-41.
- 23. Asherson RA, Liote F, Page B, Meyer O, Buchanan N et al.
Avascular necrosis of bone and antiphospholipid antibodies in
systemic lupus erythematosus. Journal of Rheumatology 1993;
20: 284-288.
- 24. Hisada R, Kato M, Ohnishi N, Sugawara E, Fujieda Y et al.
Antiphospholipid score is a novel risk factor for idiopathic
osteonecrosis of the femoral head in patients with systemic
lupus erythematosus. Rheumatology (Oxford) 2019; 58 (4):
645-649. doi: 10.1093/rheumatology/key365
- 25. Zalavras C, Shah S, Birnbaum MJ, Frenkel B. Role of apoptosis
in glucocorticoid-induced osteoporosis and osteonecrosis.
Critical Reviews in Eukaryotic Gene Expression 2003; 13: 221-
235.
- 26. Powell C, Chang C, Naguwa SM, Cheema G, Gershwin ME.
Steroid induced osteonecrosis: An analysis of steroid dosing
risk. Autoimmunity Reviews 2010; 9: 721-743.
- 27. Hiraoka M, Tsukahara H, Matsubara K, Tsurusawa M, Takeda
N et al. A randomized study of two long-course prednisolone
regimens for nephrotic syndrome in children. American
Journal of Kidney Diseases 2003; 41: 1155-1162.
- 28. Yang L, Boyd K, Kaste SC. A Mouse model for glucocorticoidinduced
osteonecrosis: effect of a steroid holiday. Journal of
Orthopaedic Research 2009; 27: 169-175.
- 29. Mattano LA Jr, Devidas M, Nachman JB, Sather HN,
Hunger SP et al. Effect of alternate-week versus continuous
dexamethasone scheduling on the risk of osteonecrosis in
paediatric patients with acute lymphoblastic leukaemia: results
from the CCG-1961 randomised cohort trial. Lancet Oncology
2012; 13 (9): 906-915.
- 30. Dumler F, Levin NW, Szego G, Vulpetti AT, Preuss LE. Longterm
alternate day steroid therapy in renal transplantation. A
controlled study. Transplantation 1982; 34: 78-82.