Avascular necrosis in patients with systemic lupus erythematosus: Prevalence, associations, risk factors and outcome.

IF 1.9 4区 医学 Q3 RHEUMATOLOGY
Lupus Pub Date : 2025-10-01 Epub Date: 2025-08-11 DOI:10.1177/09612033251369050
Çiğdem Çetin, Deniz Seyithanoğlu, Lezgin Mert, Yasemin Yalçınkaya, Ahmet Gül, Murat İnanç, Önder İsmet Kılıçoğlu, Bahar Artım Esen
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Abstract

ObjectivesAvascular necrosis (AVN) is a common complication of Systemic Lupus Erythematosus (SLE) that causes significant morbidity for patients. This study aimed to determine the prevalence of symptomatic AVN in a large SLE cohort and to determine clinical and serological risk factors for symptomatic AVN overall and in early-onset and later-onset AVN subgroups.MethodsPatients with symptomatic AVN (n = 106) and those without AVN (n = 197) were identified in a cohort of 912 patients with SLE and followed up by a standard protocol in this retrospective case control study. Osteonecrosis was recorded when there was radiological evidence. Patients who developed AVN within the first year of SLE diagnosis were compared to those at a later stage as well as all AVN patients to 197 patients without AVN matched for disease duration. SLICC SLE damage index (SDI), and the disease activity (SLEDAI-2K) were determined at AVN diagnosis.ResultsThe prevalence of symptomatic AVN in our SLE cohort (n = 912) was 11.6% (n = 106). The mean age at SLE diagnosis of AVN patients were significantly lower than non-AVN patients (27.6 ± 10.6 vs 32.5 ± 12.6; p = .003). SLE-AVN patients had significantly higher alopecia, photosensitivity, oral ulcers, vasculitic skin rash, artritis, serositis, nephritis, pulmonary hypertension and neurologic involvement than non-AVN SLE patients (p < .05). Compared with the control group, SLE patients with AVN had significantly higher anti-cardiolipin IgG, lupus anticoagulant and anti-phospholipid antibody positivity of any kind (p = .020; 0.020; 0.018, respectively). In 106 patients, AVN was found in a total of 214 joints. Of the patients, 64.2 % (n = 68) had AVN in more than 1 joint. Patients who had AVN ≤1 year after SLE diagnosis had significantly higher mean SLEDAI-2K, higher mean daily steroid dose until diagnosis, and lower age (p = .041; 0.000 and 0.001, respectively). These patients also developed AVN at multiple joints significantly more than other patients (p = .047).ConclusionWe believe that controlling disease activity in the first year of SLE diagnosis and keeping daily steroid dose at minimum levels could be important in preventing early development of debilitating AVN in multiple joints, especially in younger SLE patients.

系统性红斑狼疮患者的血管坏死:患病率、相关性、危险因素和结局。
目的:缺血性坏死(AVN)是系统性红斑狼疮(SLE)的常见并发症,导致患者的严重发病率。本研究旨在确定症状性AVN在大型SLE队列中的患病率,并确定总体、早发性和晚发性AVN亚组中症状性AVN的临床和血清学危险因素。方法在本回顾性病例对照研究中,从912例SLE患者中筛选出有症状性AVN(106例)和无AVN(197例)的患者,并采用标准方案进行随访。有影像学证据时记录骨坏死。在SLE诊断的第一年内发生AVN的患者与晚期患者进行比较,并将所有AVN患者与197名病程匹配的无AVN患者进行比较。在AVN诊断时测定SLE损害指数(SDI)和疾病活动性(SLEDAI-2K)。结果在我们的SLE队列中,有症状的AVN患病率(n = 912)为11.6% (n = 106)。AVN患者SLE诊断时的平均年龄明显低于非AVN患者(27.6±10.6 vs 32.5±12.6;P = .003)。SLE- avn患者的脱发、光敏性、口腔溃疡、血管性皮疹、关节炎、浆膜炎、肾炎、肺动脉高压和神经系统受损伤明显高于非avn SLE患者(p < 0.05)。与对照组相比,SLE合并AVN患者抗心磷脂IgG、狼疮抗凝血剂及各种抗磷脂抗体阳性均显著升高(p = 0.020;0.020;分别为0.018)。在106例患者中,共有214个关节发现AVN。64.2% (n = 68)患者有1个以上关节AVN。SLE诊断后AVN≤1年的患者SLEDAI-2K平均值较高,诊断前平均每日类固醇剂量较高,且年龄较低(p = 0.041;分别为0.000和0.001)。这些患者发生多关节AVN的几率明显高于其他患者(p = 0.047)。结论:我们认为,在SLE诊断的第一年控制疾病活动性,并将每日类固醇剂量保持在最低水平,对于预防多关节衰弱性AVN的早期发展,特别是在年轻的SLE患者中,可能是重要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Lupus
Lupus 医学-风湿病学
CiteScore
4.20
自引率
11.50%
发文量
225
审稿时长
1 months
期刊介绍: The only fully peer reviewed international journal devoted exclusively to lupus (and related disease) research. Lupus includes the most promising new clinical and laboratory-based studies from leading specialists in all lupus-related disciplines. Invaluable reading, with extended coverage, lupus-related disciplines include: Rheumatology, Dermatology, Immunology, Obstetrics, Psychiatry and Cardiovascular Research…
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