ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2258

Risk Factors for Total Joint Replacement in Systemic Lupus Erythematosus Patients with Avascular Necrosis

Jennifer Lee1, Dae-Jun Kim1, Jae Ho Lee1, Seung Min Jung1, Seung-Ki Kwok1, Ji Hyeon Ju2, Kyung-Su Park1, Sung-Hwan Park1 and Ho-Youn Kim1, 1Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea, 2Rheumatology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Systemic Lupus Erythematosus: Clinical Aspects

Session Type: Abstract Submissions (ACR)

Background/Purpose: Avascular necrosis (AVN) is a common manifestation in patients with systemic lupus erythematosus (SLE) and is associated with significant morbidity. A number of studies have been conducted to elucidate the risk factors for the development of AVN. However, clinical outcomes of AVN in patients with SLE have not been highlighted. We aimed to determine the clinical features predictive of the development of AVN in SLE patients and to elucidate the risk factors for the total joint replacement (TJR) of the affected joints in SLE patients with AVN.

Methods: The medical records of 938 patients with SLE admitted to a single center in Seoul, Korea from January 1990 to April 2012 were reviewed and 66 patients with AVN were identified. A hundred and one age-and sex-matched patients with SLE who didn’t have apparent AVN were included as disease controls. The independent risk factors for the development of AVN were examined by univariate and multivariate logistic regression analyses. The timing and cumulative risk of TJR were identified by Kaplan-Meier methods. The independent risk factors for TJR were determined by univariate and multivariate Cox proportional hazards regression analyses.

Results: The prevalence AVN was 7.0%. Multivariate logistic regression analysis revealed that the independent risk factors for the development of AVN included discoid rash (odds ratio (OR) 7.861, p=0.022), lymphopenia (OR 12.316, p=0.003), cushingoid feature (OR 3.029, p=0.02). Among 66 patients with AVN, 61 had AVN of the hip, 10 had AVN of knee and 1 had AVN of shoulder. Thirty-eight patients underwent total joint replacement (TJR) surgery. In univariate analysis, male patients, bilateral joint involvement, neuropsychiatric lupus, renal involvement, advanced radiological stage of AVN (Association for Research on Osseous Circulation (ARCO) stage) at the time of diagnosis were included as predictive risk factors for TJR. In multivariate analysis, only advanced radiological stage of AVN at the time of diagnosis was included as an independent risk factor for TJR (hazard ratio 2.464, p=0.038).

Conclusion: Our results demonstrated that advanced radiological stage at the onset of AVN is an independent predictable risk factor for TJR in SLE patients with AVN.

Disclosure:

J. Lee,
None;

D. J. Kim,
None;

J. H. Lee,
None;

S. M. Jung,
None;

S. K. Kwok,
None;

J. H. Ju,
None;

K. S. Park,
None;

S. H. Park,
None;

H. Y. Kim,
None.

« Back to 2012 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-factors-for-total-joint-replacement-in-systemic-lupus-erythematosus-patients-with-avascular-necrosis/