Session Information
Date: Sunday, November 8, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session I
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: We recently reported the frequency of symptomatic osteonecrosis (ON) among systemic lupus erythematosus (SLE) patients of the lupus cohort to be 13.6%
The aim of this study is to identify predictive factors for the development of osteonecrosis in patients with SLE.
Methods:
Patients who developed ON after clinic entry were identified from the Lupus Clinic Database. ON was defined as patients with clinical symptoms and osteonecrosis confirmed by imaging (radiographs, bone scan, CT, MRI). Cases were matched to controls (SLE patients without ON) by gender, year of entry to clinic, year of birth, and disease duration.
Univariate conditional logistic regressions were carried out on each potential predictor, and variables meeting the p-value < 0.2 or clinically regarded as important risk factors were selected for multivariate regression analysis.
Results: 1781 patients with SLE were in the Lupus Clinic Database. Of these, 171 cases of symptomatic ON were identified and 162 cases were successfully matched to controls (Table 1).
Age at ON, black race, steroid-related SLICC damage, mean total cholesterol 3 years prior to ON or last visit, mean steroid dose, cumulative steroid dose, and mean duration of immunosuppressant and bisphosphonate use were included in the multivariate analysis. Mean steroid and cumulative months on bisphosphonate were independent predictors for ON adjusting for other covariates in the model, with odds ratio and 95% confidence intervals of 1.036 (1.012, 1.061) and 1.018 (1.000, 1.035) correspondingly. However, only small numbers of patients were on bisphosphonate therapy (cases = 28, controls = 16).
Table 1
|
|
Cases (n=162) |
Controls (n-162) |
|
Female gender |
148 (91.4%) |
148 (91.4%) |
|
Age at ON or last visit (years)* |
36.98 ± 12.45 |
37.48 ± 12.34 |
|
Age at SLE diagnosis (years)* |
27.77 ± 10.56 |
27.94 ± 9.74 |
|
Black Race |
30 (18.5%) |
16 (9.9%) |
|
Disease duration at ON/last visit (years)* |
9.35 ± 8.75 |
9.54 ± 9.05 |
|
AMS 3 years before ON/last visit* |
6.17 ± 4.73 |
6.10 ± 5.94 |
|
AMS without dsDNA or complement 3 years before ON/last visit* |
5.43 ± 4.47 |
5.36 ± 5.77 |
|
SLICC at ON/last visit* |
1.29 ± 1.56 |
1.04 ± 1.63 |
|
SLICC steroid-related damage at ON/last visit* |
1.07 ± 1.36 |
0.79 ± 1.31 |
|
Raynaud’s ever before ON/last visit |
83 (51.2%) |
94 (58.0%) |
|
Smoking ever at ON/last visit |
49 (30.2%) |
54 (33.3%) |
|
CNS ever at ON/last visit |
69 (42.6%) |
61 (37.7%) |
|
Vasculitis ever at ON/last visit |
51 (31.5%) |
45 (27.8%) |
|
Arthritis ever at ON/last visit |
46 (28.4%) |
51 (31.5%) |
|
Renal ever at ON/last visit |
94 (58.0%) |
100 (61.7%) |
|
Total cholesterol 3 yrs before ON or last visit* |
5.39 ± 1.22 |
5.08 ± 1.49 |
|
APLA positivity ever at ON/last visit |
37 (22.8%) |
41 (25.3%) |
|
Cumulative steroids dose to ON/last visit (g)* |
31.00 ± 30.11 |
23.74 ± 40.98 |
|
Average steroids dose to ON/last visit (mg)* |
17.14 ± 11.15 |
11.81 ± 12.87 |
|
Antimalarial treatment before ON/last visit |
103 (63.6%) |
106 (65.4%) |
|
Duration of immunosuppressive treatment before ON/last visit (months)* |
22.88 ± 35.05 |
16.98 ± 39.06 |
|
Duration of bisphosphonate treatment before ON/ last visit (months)* |
5.23 ± 20.98 |
2.85 ± 13.01 |
*Mean ± standard deviation
Conclusion: Osteonecrosis remains an important comorbidity among patients with SLE, and corticosteroid use remains a significant risk factor. Continued judicious use of corticosteroid therapy is needed in mitigating this event, and ongoing studies are needed to identify additional predictive factors.
To cite this abstract in AMA style:
Dhillon N, Gladman D, Su J, Urowitz M. Osteonecrosis in Systemic Lupus Erythematosus: Predictive Factors [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/osteonecrosis-in-systemic-lupus-erythematosus-predictive-factors/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/osteonecrosis-in-systemic-lupus-erythematosus-predictive-factors/