Time trend and risk factors of avascular bone necrosis in patients with systemic lupus erythematosus

Lupus ◽  
2016 ◽  
Vol 26 (7) ◽  
pp. 715-722 ◽  
Author(s):  
Sau Mei Tse ◽  
Chi Chiu Mok
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Logistic Regression ◽  
Cumulative Dose ◽  
Lupus Erythematosus ◽  
Time Trend ◽  
High Dose ◽  
Systemic Lupus ◽  
Bone Necrosis ◽  
Avascular Bone Necrosis

Objectives The objective of this paper is to study the time trend and risk factors of avascular bone necrosis (AVN) in patients with systemic lupus erythematosus (SLE). Methods Between 1999 and 2014, patients who fulfilled the ACR criteria for SLE and developed symptomatic AVN were identified from our cohort database and compared with those without AVN, matched for age, sex and SLE duration. The standardized incidence ratios (SIRs) of AVN in different SLE age groups were calculated from data derived from our hospital registry and population census. Risk factors for AVN were studied by logistic regression, adjusted by a propensity score for ever use of high-dose glucocorticoids (GCs). Results Fifty-five SLE patients with AVN and 220 SLE patients without AVN were studied. There were 104 AVN sites involved, with the hips being most commonly affected (82%). The point prevalence of AVN in our SLE cohort was 7.4%. The SIRs of AVN in our SLE patients were 131 (86.6–199; p < 0.001) and 56.0 (34.3–91.4; p < 0.001), respectively, in the periods 1995–2004 and 2005–2014. In both decades, the age-stratified SIR was highest in the youngest age group (<19 years). AVN patients were more likely to be treated with GCs and had received a significantly higher cumulative dose of prednisolone since SLE diagnosis (16.5 vs 10.7 grams; p = 0.001). The SLE damage score (excluding AVN) was also significantly higher in AVN than non-AVN patients (2.5 vs 0.4; p < 0.001). Logistic regression revealed that preceding septic arthritis of the involved joint (odds ratio (OR) 17.7 (1.5–205); p = 0.02), cushingoid body habitus (OR 2.4 (1.1–5.2); p = 0.04), LDL cholesterol level (OR 1.4 (1.0–1.9); p = 0.04), maximum daily dose of prednisolone (OR 6.4 (1.2–33.3); p = 0.03) and cumulative dose of prednisolone received in the first six months of the first lupus flare (OR 1.3 (1.0–1.8); p = 0.046) were independently associated with AVN. Conclusions AVN is prevalent in SLE, particularly in younger patients. The use of GCs remains the strongest independent risk factor. A trend of reduction in the SIR of AVN in our SLE patients is observed over the past two decades.

Risk factors for avascular bone necrosis in patients with systemic lupus erythematosus

2010 ◽  
Vol 32 (1) ◽  
pp. 177-182 ◽  
Author(s):  
Mehmet Sayarlioglu ◽  
Nergis Yuzbasioglu ◽  
Murat Inanc ◽  
Sevil Kamali ◽  
Ayse Cefle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Bone Necrosis ◽  
Avascular Bone Necrosis

scholarly journals BEYOND CORTICOSTEROIDS: RISK FACTORS FOR AVASCULAR BONE NECROSIS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

2019 ◽  
Author(s):  
LARISSA DE BARROS OLIVEIRA ◽  
ADIB CHICRE MANSUR NETO ◽  
MAURO GOLDFARB ◽  
MARILENA LEAL MESQUITA SILVESTRE FERNANDES ◽  
ADRIANA DANOWSKI
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Bone Necrosis ◽  
Avascular Bone Necrosis

scholarly journals Protesa obturator definitif resin akrilik pada pasien systemic lupus erythematosus (SLE) pasca maksilektomi

2020 ◽  
Vol 32 (2) ◽  
pp. 63
Author(s):  
Pramudya Aditama ◽  
Erwan Sugiatno ◽  
Murti Indrastuti ◽  
Endang Wahyuningtyas
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Wire Mesh ◽  
Systemic Lupus ◽  
Bone Necrosis ◽  
Avascular Bone Necrosis ◽  
Titanium Wire

ABSTRAKPendahuluan: Systemic lupus erythematosus (SLE) merupakan inflamasi kronis yang dapat melibatkan sistem saraf, membran mukosa, dan organ lain dalam tubuh. Avascular bone necrosis (AVN) merupakan gejala yang muncul pada penderita SLE. Maksilektomi dilakukan pada tulang maksila yang mengalami AVN. Penutupan celah pasca maksilektomi tersebut dilakukan dengan cara  menggunakan protesa maksilofasial intraoral yaitu obturator. Tujuan laporan kasus ini mengkaji rehabilitasi prostetik menggunakan protesa obturator definitif resin akrilik pada penderita SLE pasca maksilektomi. Laporan kasus: Seorang wanita berusia 21 tahun datang ke Poli Gigi dan Mulut RSUP Dr. Sardjito dengan keluhan bau mulut, hilangnya gusi pada langit-langit, dan kegoyahan gigi rahang atas. Pasien didiagnosis SLE sejak lebih dari 1 tahun yang lalu. Pada pemeriksaan intraoral, selain lesi pada mukosa palatum, ditemukan juga nekrosis pada tulang palatum, kehilangan gigi 14, 15, 16, dan 25, serta kegoyahan derajat 3 pada seluruh gigi rahang atas yang tersisa. Pasien dirawat dengan obat Myfortic (2 x 180 mg/hari) dan Fluconazole (1x150 mg/hari) kemudian dirujuk ke Poli Bedah Mulut untuk dilakukan maksilektomi, dilanjutkan dengan pembuatan protesa obturator oleh tim prostodonti. Pasien dibuatkan obturator pasca bedah untuk menutup celah palatum pasca maksilektomi. Pencetakan menggunakan bahan hydrocolloid irreversible sebelum operasi untuk pembuatan obturator pasca bedah. Insersi obturator menunjukkan celah palatum tertutup rapat oleh plat akrilik. Retensi didapatkan menggunakan kawat stainless pada titanium wire mesh pengganti tulang maksila. Tidak ada keluhan saat kontrol, penelanan baik. Tiga bulan pasca pemakaian obturator pasca bedah dilakukan pemasangan obturator definitif resin akrilik rahang atas. Pemeriksaan klinis menunjukkan suara sengau berkurang, estetis, dan pengunyahan baik. Simpulan: Protesa obturator definitif resin akrilik pada pasien SLE pasca maksilektomi dapat mengembalikan fungsi estetik, mengurangi suara sengau (mengembalikan fungsi bicara), mengembalikan fungsi penelanan, dan pengunyahan.

Synergistic effect of cumulative corticosteroid dose and immunosuppressants on avascular necrosis in patients with systemic lupus erythematosus

Lupus ◽  
2018 ◽  
Vol 27 (10) ◽  
pp. 1644-1651 ◽  
Author(s):  
H H Kwon ◽  
S Y Bang ◽  
S Won ◽  
Y Park ◽  
J H Yi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Avascular Necrosis ◽  
Lupus Erythematosus ◽  
Clinical Manifestations ◽  
Individual Risk ◽  
High Dose ◽  
Systemic Lupus ◽  
Corticosteroid Dose ◽  
Increased Risk

Objectives Avascular necrosis (AVN) is one of the most common causes of organ damage in patients with systemic lupus erythematosus (SLE) and often causes serious physical disability. The aims of this study were to investigate clinical risk factors associated with symptomatic AVN and to analyze their synergistic effects in a large SLE cohort in Korea. Methods Patients with SLE were enrolled and followed from 1998 to 2014 in the Hanyang BAE Lupus cohort, and damage was measured annually according to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). AVN was confirmed by imaging study if patients had symptoms. To determine risk factors for AVN, clinical, laboratory and therapeutic variables were analyzed by logistic regression. Relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S) were calculated to measure interactions between significant variables. Results Among 1219 SLE patients, symptomatic AVN was the most common type of musculoskeletal damage (10.8%, n = 132). SLE patients with AVN showed an earlier onset age, demonstrated AVN more commonly in conjunction with certain other clinical manifestations such as renal and neuropsychiatric disorders, and received significantly higher total cumulative corticosteroid dose and immunosuppressive agents than did patients without AVN. However, in multivariable analysis, only two variables including use of a cumulative corticosteroid dose greater than 20 g (odds ratio (OR) 3.62, p = 0.015) and use of immunosuppressants including cyclophosphamide or mycophenolate mofetil (OR 4.51, p < 0.001) remained as significant risk factors for AVN. Patients with cumulative corticosteroid dose > 20 g and immunosuppressant use had a 15.44-fold increased risk for AVN, compared with patients without these risk factors ( p < 0.001). RERI, AP and S, which define the strength of interactions between two risk factors, were 9.01 (95% confidence interval (CI) 1.30–16.73), 0.58 (95% CI 0.36–0.81) and 2.66 (95% CI 1.42–4.99), respectively, supporting the presence of synergistic interactions in the development of symptomatic AVN in our Korean lupus cohort. Conclusions An individual risk assessment for AVN development should be made prior to and during treatment for SLE, especially in patients with high-dose corticosteroid and immunosuppressant use regardless of clinical manifestations and disease activity.

scholarly journals Asymptomatic Coronary Artery Calcifications in Men with Systemic Lupus Erythematosus

2018 ◽  
Vol 45 (5) ◽  
pp. 663-670 ◽  
Author(s):  
Juanita Romero-Díaz ◽  
Roberto Iván Acosta-Hernández ◽  
Sergio Criales-Vera ◽  
Erick Kimura-Hayama ◽  
Maricruz Domínguez-Quintana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Coronary Artery ◽  
Cumulative Dose ◽  
Lupus Erythematosus ◽  
Coronary Artery Calcification ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Coronary Artery Atherosclerosis ◽  
Age And Sex

Objective.To determine whether the prevalence and extent of asymptomatic coronary artery atherosclerosis are increased in men with systemic lupus erythematosus (SLE) compared with age- and sex-matched controls, and to define the associated risk factors.Methods.Ninety-five patients with SLE (mean ± SD age, 34.7 ± 10.1 yrs) and 100 control subjects (age 34.8 ± 9.7 yrs) with no history of coronary artery disease were screened for coronary artery calcification using multidetector computed tomography. The extent of calcification was measured using the Agatston score. The frequency of risk factors for calcification was compared between patients and controls, and the relationship between clinical and immunological characteristics and the presence of coronary artery calcification was investigated.Results.Coronary artery calcification was more frequent in patients than controls [18% vs 7%, respectively (OR 2.89, 95% CI 1.07–8.65)]. These factors were independently associated with the presence of calcifications: age (OR 1.12, 95% CI 1.04–1.20), SLE diagnosis (OR 3.38, 95% CI 1.07–10.64), diabetes mellitus (OR 6.88, 95% CI 1.50–31.62), Framingham risk score (OR 1.12, 95% CI 1.00–1.23), and glomerular filtration rate (OR 0.98, 95% CI 0.96–1.00). Among patients with SLE, coronary artery calcifications were observed starting at age 32 years, within 2.3 years of diagnosis. Increasing age (OR 1.18, 95% CI 1.06–1.31), Systemic Lupus International Collaborating Clinics score (OR 2.85, 95% CI 1.21–6.73), and cumulative dose of prednisone (OR 1.04, 95% CI 1.01–1.08) were independent risk factors.Conclusion.Men with SLE are at an increased risk of coronary artery calcifications than age- and sex-matched controls. Among patients with SLE, the increased risk is associated to older age, increasing chronic damage, and cumulative dose of corticosteroids.

Prevalence, risk factors, and impact on mortality of neuropsychiatric lupus: a prospective, single-center study

Lupus ◽  
2018 ◽  
Vol 27 (8) ◽  
pp. 1338-1347 ◽  
Author(s):  
G Y Ahn ◽  
D Kim ◽  
S Won ◽  
S T Song ◽  
H-J Jeong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Lupus Erythematosus ◽  
Antiphospholipid Antibody ◽  
Systemic Lupus ◽  
Multivariable Logistic Regression ◽  
Risk Of Mortality ◽  
Antibody Positivity

Objective The objective of this paper is to identify the prevalence, risk factors, and impact on mortality of neuropsychiatric systemic lupus erythematosus (NPSLE). Methods Patients from the Hanyang BAE lupus cohort were registered and followed from 1998 to 2015. NPSLE was defined using American College of Rheumatology (ACR) case definitions and Ainiala criteria. Demographics, autoantibodies, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and Systemic Lupus International Collaborating Clinic (SLICC)/ACR Damage Index were collected at baseline and then annually. Mortality data were derived by linking data from the Korean National Statistics Office. Multivariable logistic regression and Cox regression analysis were conducted in the inception cohort to assess the risk factors and mortality impact of NPSLE. Results Of 1121 registered patients, 429 (38.3%) had NPSLE manifestations according to ACR criteria and 216 (19.3%) by Ainiala criteria. In multivariable logistic regression analysis, higher SLEDAI (OR 1.08, CI 1.01–1.16, p = 0.02) and antiphospholipid antibody positivity (OR 1.72, CI 1.03–2.87, p = 0.04) at SLE diagnosis increased NPSLE risk, while elevated anti-dsDNA antibodies (OR 0.43, CI 0.24–0.78, p < 0.01) and greater education duration (OR 0.92, CI 0.85–1.00, p = 0.04) showed reduced risk of NPSLE. Cox proportional hazard models demonstrated that presence of NPSLE had a three-fold increased risk of mortality (HR 3.09, CI 1.03–9.21, p = 0.04), especially in patients with focal CNS NPSLE (HR = 7.83, CI 2.12–28.96, p < 0.01). Conclusion Higher SLEDAI, antiphospholipid antibody positivity, absence of anti-dsDNA antibody at SLE diagnosis, and fewer years of education are risk factors for development of NPSLE. Presence of NPSLE, especially focal CNS NPSLE, increased the risk of mortality in SLE patients.

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