Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan.
Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
RMD Open. 2023 Feb;9(1). doi: 10.1136/rmdopen-2022-002787.
We aimed to determine the prevalence and risk factors for osteonecrosis of the femoral head (ONFH) in a multicentre cohort of patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).
One hundred and eighty-six AAV patients who underwent radiographs and MRI screening of bilateral hip joints at more than 6 months after initial remission induction therapy (RIT) were retrospectively assessed for the presence of ONFH.
Among 186 AAV patients, 33 (18%) were diagnosed with ONFH. Among the patients with ONFH, 55% were asymptomatic and 64% had bilateral ONFH. Seventy-six per cent of ONFH joints were in precollapse stages (stage ≤2), whereas 24% of ONFH joints were in collapse stages (stage ≥3). Moreover, 56% of the precollapse stage joints were already at risk of future collapse (type ≥C-1). Even in asymptomatic ONFH patients, 39% of the precollapse stage joints were type ≥C-1. Prednisolone dose of ≥20 mg/day on day 90 of RIT was an independent risk factor for ONFH in AAV patients (OR 1.072, 95% CI 1.017 to 1.130, p=0.009). Rituximab use was a significant beneficial factor against ONFH (p=0.019), but the multivariate analysis rejected its significance (p=0.257).
Eighteen per cent of AAV patients developed ONFH, and two-thirds of the ONFH joints were already in collapse stages or at risk of future collapse. Prednisolone dose of ≥20 mg/day on day 90 of RIT was an independent risk factor for ONFH. A rapid reduction of glucocorticoids in RIT and early detection of precollapse ONFH by MRI may decrease and intervene ONFH development in AAV patients.
我们旨在确定多中心队列的抗中性粒细胞胞浆抗体相关性血管炎（AAV）患者中股骨头坏死（ONFH）的患病率和危险因素。
回顾性评估 186 例 AAV 患者，这些患者在初始缓解诱导治疗（RIT）后 6 个月以上接受了双侧髋关节的 X 线和 MRI 筛查，以确定是否存在 ONFH。
在 186 例 AAV 患者中，33 例（18%）被诊断为 ONFH。在患有 ONFH 的患者中，55%为无症状，64%为双侧 ONFH。76%的 ONFH 关节处于塌陷前阶段（分期≤2），而 24%的 ONFH 关节处于塌陷阶段（分期≥3）。此外，56%的塌陷前阶段关节已经有未来塌陷的风险（类型≥C-1）。即使在无症状的 ONFH 患者中，56%的塌陷前阶段关节也已经达到了 C-1 类型。RIT 第 90 天泼尼松剂量≥20mg/天是 AAV 患者发生 ONFH 的独立危险因素（OR 1.072，95%CI 1.017 至 1.130，p=0.009）。利妥昔单抗的使用是预防 ONFH 的显著有利因素（p=0.019），但多变量分析否定了其意义（p=0.257）。
18%的 AAV 患者发生了 ONFH，三分之二的 ONFH 关节已经处于塌陷阶段或有未来塌陷的风险。RIT 第 90 天泼尼松剂量≥20mg/天是 ONFH 的独立危险因素。在 RIT 中快速减少糖皮质激素和通过 MRI 早期检测塌陷前 ONFH 可能会降低和干预 AAV 患者的 ONFH 发展。
