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Article: Risk factors for avascular bone necrosis in systemic lupus erythematosus

TitleRisk factors for avascular bone necrosis in systemic lupus erythematosus
Authors
KeywordsAvascular bone necrosis
Complication
Corticosteroid
Lupus anticoagulant
Musculoskeletal
Issue Date1998
PublisherOxford University Press. The Journal's web site is located at http://rheumatology.oxfordjournals.org/
Citation
British Journal Of Rheumatology, 1998, v. 37 n. 8, p. 895-900 How to Cite?
AbstractObjective. To study the predictive factors for avascular necrosis (AVN) of bone in patients with systemic lupus erythematosus (SLE). Method. The records of 38 SLE patients who developed clinically apparent AVN during the course of their disease were reviewed. Information on clinical presentation, corticosteroid usage and autoantibody profiles was obtained, and comparison was made between these patients and 143 consecutive control SLE patients who did not have AVN. Results. The point prevalence of AVN in our SLE population was 12%. Patients with AVN, when compared with controls, had a significantly higher incidence of neurological disease (39% vs 14%; P < 0.001) and Cushingoid body habitus after steroid treatment (79% vs 53%; P = 0.004). The highest cumulative prednisolone dose in 1 and 4 months was significantly higher in the AVN group than the controls (1.8 vs 1.1 and 4.5 vs 2.8 g, respectively; P < 0.01 in both) and showed a linear trend with the incidence of AVN (χ 2 test for trend, P < 0.01 in both). Lupus anticoagulant was associated with AVN (P = 0.02, odds ratio 2.88 [1.14-7.28]). Logistic regression analysis revealed that the highest cumulative prednisolone dose administered in 4 months, the maximum and mean daily prednisolone dosage, and the lupus anticoagulant were independent risk factors for AVN. Conclusions. Corticosteroid remains the major predisposing factor for AVN in SLE. Patients who require an initial high-dose steroid for disease control are at risk of AVN, especially if they are positive for the lupus anticoagulant or develop Cushingoid habitus after steroid treatment. High-risk patients should be closely monitored so that early AVN can be diagnosed by sensitive techniques such as magnetic resonance imaging and radioisotope bone scanning.
Persistent Identifierhttp://hdl.handle.net/10722/49089
ISSN
2000 Impact Factor: 3.949
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorMok, CCen_HK
dc.contributor.authorLau, CSen_HK
dc.contributor.authorWong, RWSen_HK
dc.date.accessioned2008-06-12T06:34:10Z-
dc.date.available2008-06-12T06:34:10Z-
dc.date.issued1998en_HK
dc.identifier.citationBritish Journal Of Rheumatology, 1998, v. 37 n. 8, p. 895-900en_HK
dc.identifier.issn0263-7103en_HK
dc.identifier.urihttp://hdl.handle.net/10722/49089-
dc.description.abstractObjective. To study the predictive factors for avascular necrosis (AVN) of bone in patients with systemic lupus erythematosus (SLE). Method. The records of 38 SLE patients who developed clinically apparent AVN during the course of their disease were reviewed. Information on clinical presentation, corticosteroid usage and autoantibody profiles was obtained, and comparison was made between these patients and 143 consecutive control SLE patients who did not have AVN. Results. The point prevalence of AVN in our SLE population was 12%. Patients with AVN, when compared with controls, had a significantly higher incidence of neurological disease (39% vs 14%; P < 0.001) and Cushingoid body habitus after steroid treatment (79% vs 53%; P = 0.004). The highest cumulative prednisolone dose in 1 and 4 months was significantly higher in the AVN group than the controls (1.8 vs 1.1 and 4.5 vs 2.8 g, respectively; P < 0.01 in both) and showed a linear trend with the incidence of AVN (χ 2 test for trend, P < 0.01 in both). Lupus anticoagulant was associated with AVN (P = 0.02, odds ratio 2.88 [1.14-7.28]). Logistic regression analysis revealed that the highest cumulative prednisolone dose administered in 4 months, the maximum and mean daily prednisolone dosage, and the lupus anticoagulant were independent risk factors for AVN. Conclusions. Corticosteroid remains the major predisposing factor for AVN in SLE. Patients who require an initial high-dose steroid for disease control are at risk of AVN, especially if they are positive for the lupus anticoagulant or develop Cushingoid habitus after steroid treatment. High-risk patients should be closely monitored so that early AVN can be diagnosed by sensitive techniques such as magnetic resonance imaging and radioisotope bone scanning.en_HK
dc.format.extent420 bytes-
dc.format.mimetypetext/html-
dc.languageengen_HK
dc.publisherOxford University Press. The Journal's web site is located at http://rheumatology.oxfordjournals.org/en_HK
dc.relation.ispartofBritish Journal of Rheumatologyen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subjectAvascular bone necrosisen_HK
dc.subjectComplicationen_HK
dc.subjectCorticosteroiden_HK
dc.subjectLupus anticoagulanten_HK
dc.subjectMusculoskeletalen_HK
dc.titleRisk factors for avascular bone necrosis in systemic lupus erythematosusen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0263-7103&volume=37&issue=8&spage=895&epage=900&date=1998&atitle=Risk+factors+for+avascular+bone+necrosis+in+systemic+lupus+erythematosusen_HK
dc.identifier.emailLau, CS:cslau@hku.hken_HK
dc.identifier.authorityLau, CS=rp01348en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1093/rheumatology/37.8.895en_HK
dc.identifier.pmid9734682-
dc.identifier.scopuseid_2-s2.0-0031851207en_HK
dc.identifier.hkuros40632-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0031851207&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume37en_HK
dc.identifier.issue8en_HK
dc.identifier.spage895en_HK
dc.identifier.epage900en_HK
dc.identifier.isiWOS:000075407700012-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridMok, CC=34668219600en_HK
dc.identifier.scopusauthoridLau, CS=14035682100en_HK
dc.identifier.scopusauthoridWong, RWS=34875928200en_HK

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