Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-0856, Japan.
Rheumatology (Oxford). 2011 Nov;50(11):2023-8. doi: 10.1093/rheumatology/ker277. Epub 2011 Aug 24.
The purpose of this study was to clarify the incidence of (CS)-associated osteonecrosis among different underlying diseases and to evaluate the risk factors for steroid-associated osteonecrosis in a prospective MRI study.
We prospectively used MRI to study 337 eligible underlying disease patients requiring CS therapy and succeeded in examining 1199 joints (hips and knees) in 302 patients with MRI for at least 1 year starting immediately after the onset of CS therapy (1-year follow-up rate of 90%). The underlying diseases included SLE in 687 joints (173 patients) and a variety of other rheumatological disorders in 512 joints (129 patients).
The incidence of osteonecrosis was significantly higher in SLE patients than in non-SLE patients (37 vs 21%, P = 0.001). Logistic regression analysis revealed that adolescent and adult patients had a significantly higher risk of osteonecrosis compared with paediatric patients [odds ratio (OR) = 13.2], that high daily CS dosage (>40 mg/day) entailed a significantly higher risk of osteonecrosis compared with the dosage of <40 mg/day (OR = 4.2), that SLE patients had a significantly higher risk of osteonecrosis compared with non-SLE patients (OR = 2.6) and that male patients had a significantly higher risk of osteonecrosis compared with female patients (OR = 1.6).
These findings suggest that the incidence of CS-associated osteonecrosis varies among different underlying diseases.
本研究旨在阐明不同基础疾病中 CS 相关骨坏死的发生率，并在一项前瞻性 MRI 研究中评估类固醇相关骨坏死的危险因素。
我们前瞻性地使用 MRI 研究了 337 名符合条件的需要 CS 治疗的基础疾病患者，在开始 CS 治疗后立即对 302 名患者的 1199 个关节（髋关节和膝关节）进行了至少 1 年的 MRI 检查（1 年随访率为 90%）。基础疾病包括 SLE 中的 687 个关节（173 名患者）和其他各种风湿病中的 512 个关节（129 名患者）。
骨坏死的发生率在 SLE 患者中明显高于非 SLE 患者（37%比 21%，P=0.001）。Logistic 回归分析显示，与儿科患者相比，青少年和成年患者发生骨坏死的风险显著更高[比值比（OR）=13.2]，与 <40mg/天的剂量相比，每天使用高剂量 CS（>40mg/天）发生骨坏死的风险显著更高（OR=4.2），SLE 患者发生骨坏死的风险明显高于非 SLE 患者（OR=2.6），男性患者发生骨坏死的风险明显高于女性患者（OR=1.6）。
这些发现表明 CS 相关骨坏死的发生率在不同基础疾病中有所不同。
