Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.
Department of Internal Medicine, International Medical University, Kuala Lumpur, Malaysia.
PLoS One. 2021 Mar 19;16(3):e0248845. doi: 10.1371/journal.pone.0248845. eCollection 2021.
Avascular necrosis of bone (AVN) is increasingly being recognized as a complication of SLE and causes significant disability due to pain and mobility limitations. We studied the prevalence and factors associated with avascular necrosis (AVN) in a multiethnic SLE cohort. SLE patients who visited the outpatient clinic from October 2017 to April 2019 were considered eligible. Their medical records were reviewed to identify patients who developed symptomatic AVN, as confirmed by either magnetic resonance imaging or plain radiography. Subsequently, their SLE disease characteristics and treatment were compared with the characteristics of patients who did not have AVN. Multivariable logistic regression analyses were performed to determine the independent factors associated with AVN among the multiethnic SLE cohort. A total of 390 patients were recruited, and the majority of them were females (92.6%); the patients were predominantly of Malay ethnicity (59.5%), followed by Chinese (35.9%) and Indian (4.6%). The prevalence of symptomatic AVN was 14.1%, and the mean age of AVN diagnosis was 37.6 ± 14.4 years. Both univariate and multivariable logistic regression analyses revealed that a longer disease duration, high LDL-C (low density lipoprotein cholesterol), positive anti-cardiolipin (aCL) IgG and anti-dsDNA results, a history of an oral prednisolone dose of more than 30 mg daily for at least 4 weeks and osteoporotic fractures were significantly associated with AVN. On the other hand, hydroxychloroquin (HCQ), mycophenolate mofetil (MMF) and bisphosphonate use were associated with a lower risk of AVN. No associations with ethnicity were found. In conclusion, several modifiable risk factors were found to be associated with AVN, and these factors may be used to identify patients who are at high risk of developing such complications. The potential protective effects of HCQ, MMF and bisphosphonates warrant additional studies.
骨坏死（AVN）越来越被认为是 SLE 的一种并发症，由于疼痛和活动受限，会导致严重的残疾。我们研究了一个多民族 SLE 队列中 AVN 的患病率和相关因素。2017 年 10 月至 2019 年 4 月期间，我们考虑在门诊就诊的 SLE 患者符合入选条件。对他们的病历进行了审查，以确定患有症状性 AVN 的患者，这些患者通过磁共振成像或 X 线平片得到证实。随后，我们比较了患有和不患有 AVN 的患者的 SLE 疾病特征和治疗情况。对多民族 SLE 队列进行了多变量逻辑回归分析，以确定与 AVN 相关的独立因素。共招募了 390 名患者，其中大多数为女性（92.6%）；患者主要为马来族裔（59.5%），其次是华族（35.9%）和印度族裔（4.6%）。症状性 AVN 的患病率为 14.1%，AVN 诊断的平均年龄为 37.6±14.4 岁。单变量和多变量逻辑回归分析均显示，病程较长、LDL-C（低密度脂蛋白胆固醇）较高、抗心磷脂（aCL）IgG 和抗 dsDNA 结果阳性、曾每日口服泼尼松剂量超过 30mg 且持续至少 4 周、骨质疏松性骨折与 AVN 显著相关。另一方面，羟氯喹（HCQ）、吗替麦考酚酯（MMF）和双磷酸盐的使用与较低的 AVN 风险相关。种族与 AVN 无相关性。总之，发现了一些可改变的危险因素与 AVN 相关，这些因素可能用于识别发生此类并发症风险较高的患者。HCQ、MMF 和双磷酸盐的潜在保护作用需要进一步研究。
