The Prevalence And Risk Factors Of Avascular Necrosis Of Bone In Patients With Systemic Lupus Erythematosus

Objective To determine the clinical features and laboratory features for avascularnecrosis (AVN) in patients with systemic lupus erythematosus (SLE).Methods (1) Four electronic databases (PubMed, Embase, Ovid, Science Direct) weresearched. The search was performed to identify the articles as to SLE with AVNbefore Sep2013. The demographic and clinical data, as well as the data gotten fromlaboratory were extracted, and a meta-analysis was performed to identify theprevalence and risk factors of AVN in patients with SLE. Publication bias wasassessed with funnel plot and egger’s test. Study quality of risk factors meta-analysiswas assessed using the Newcastle-Ottawa Scale (NOS) checklist for case controlstudies.(2) Case-control study was made in our research. Case group was made up of25SLE patients with ONF. They were in patients of Rheumatology and Immunologyfrom January,2001to December,2010. Information on clinical features andlaboratory features were extracted. Control group were SLE patients who did notdevelop osteonecrosis of the femeral head (ONF). Case and control group werematched in gender, age. Patients in case and control groups were in-patients from thesame period. SPSS17.0statistical software was adopted. Chi-Square test and T-testwere adopted. Then multiple factors Logistic regression analysis was made.Results (1)955papers were retrieved from electronic and hand searches;24studiesconsisting of7513patients were finally included. The prevalence of AVN in patientswho had been cured by corticosteroid with SLE is19.9%(11.6%-28.2%); the overallprevalence of AVN in SLE patients is9.2%(7.4%-11.0%). Further,19studies withoverall SLE patients were analysed in subgroup. The prevalence of femoral head AVN in SLE patient is12.8%（95%CI:6.8-18.9）, and the prevalence of multiple jointAVN in SLE patient is8.4%(95%CI:6.5-10.4). The pooled prevalence is10.6%(95%CI:6.9-14.3) in1997ACR group,7.0%(95%CI:4.4-9.5) in1982ARA group,and5.0%(95%CI:3.0-7.0) in1971ARA group. The prevalence values in the Asianand North American were pooled at8.7%(95%CI:6.3-11.1) and10.1%(95%CI:7.2-13.0), respectively.995papers were found from four databases,16studies werefinally included. Pooled analysis showed the following result. Arthritis (OR=2.448,95%CI=1.6173.707), Cushing (OR=3.890,95%CI=1.5919.510), gastrointestinalinvolvement (OR=2.054,95%CI=1.2833.290), hypertension (OR=1.482,95%CI=1.0932.008), oral ulcers (OR=1.877,95%CI=1.1822.979), pleuritis (OR=2.302,95%CI=1.3254.001), renal disease(OR=1.475,95%CI=1.1241.936), vasculitis(OR=2.59195%CI=1.3584.944) were relevant with AVN occurring in SLE patients.There was no significant laboratory feature appeared in this pooled analysis.(2) Theprevalence of AVN in SLE patients was2.8%in Anhui Provincial Hospital.One-factor statistical analysis: lupus nephritis (χ2=9.628, P=0.002), Raynaud’sphenomenon (χ2=6.304, P=0.012), proteinuria (χ2=7.708, P=0.005) and pyuria (χ2=3.896, P=0.048) were the risk factors of AVN appeared in SLE patients in the clinicfeatures and laboratory features before ONF was diagnosis group; CNS involvement(χ2=5.469, P=0.019), oral ulcers (χ2=11.842, P=0.001), photosensitivity (χ2=6.510,P=0.011), lupus nephritis (χ2=6.010, P=0.014), Raynaud’s phenomenon (χ2=14.246,P<0.001), alopecia (χ2=4.527, P=0.033), ds-DNA (χ2=5.070, P=0.024) andthrombocytosis (χ2=4.199, P=0.040) were risk factors in cumulative symptoms ofONF group. Multiple factor Logistic regression analysis: oral ulcers (OR=4.76695%CI:1.083-20.979P=0.039) and Raynaud’s phenomenon (OR=5.04895%CI:1.171-21.769P=0.030) were the risk factors in cumulative symptoms of ONF group.Conclusions The prevalence of AVN in patients with SLE was9.2%. Arthritic,Cushing, gastrointestinal involvement, hypertension, oral ulcers, pleuritis, renaldisease and vasculitis may contribute to AVN in SLE patients. The prevalence of AVN in SLE patients in Anhui Province Hospital，and no risk factors was find in theclinic features and laboratory features before ONF was diagnosis. But Oral ulcers andReynaud’s phenomenon are the risk factor in cumulative symptoms of ONF research.The may caused by the same risk factors or mechanism between ONF and theseclinical features.