Risk factors for osteonecrosis severity among Egyptian systemic lupus erythematosus patients: Magnetic resonance imaging (MRI) staging

• Main Authors: Sherin M.H. Hamza, Nermine Samy, Takwa B. Younes, Amal I.A. Othman
• Format: Article
• Language: English
• Published: Elsevier 2019-10-01
• Series: Egyptian Rheumatologist
• Online Access: http://www.sciencedirect.com/science/article/pii/S1110116418301467

Aim of the work: To determine the risk factors of bilateral and severe (advanced) osteonecrosis femoral head (ONFH) as assessed by magnetic resonance imaging (MRI) staging in Egyptian SLE patients. Patients and methods: Sixty SLE patients were studied and subdivided into two groups according to the presence or absence of symptomatic osteonecrosis. Full medical history, musculoskeletal examination, laboratory and serologic tests were done to all patients. SLE disease activity index (SLEDAI), systemic lupus international collaboration clinics damage index (SLICC/DI), health assessment questionairre (HAQ) disability index and the visual analogue scale (VAS-pain) were assessed. 30 patients with symptomatic ONFH were identified and staged by MRI according to Ficat and Arlet classification. Dual energy x-ray absorptiometry (DEXA) scan was performed. Results: The mean age at-onset of patients with ONFH was significantly lower than those without (20.7 ± 5.9 vs 30.4 ± 7.9 years; p < 0.0001) with comparable genders (F:M 29:1 vs 26:4; p = 0.16). SLEDAI, SLICC/DI, HAQ were significantly increased (p = 0.001 each) and DEXA reduced (p = 0.02) in those with ONFH. Predictors of ONFH severity included the presence of serositis (p = 0.005), arthritis (p = 0.02), gastrointestinal (GI) manifestations (p = 0.005), cardiac involvement (p = 0.049), diabetes (p = 0.01), elevated creatinine (0.008), urine sediments (p = 0.006), VAS-pain (p = 0.005), steroids (p = 0.015) and absence of hydroxychloroquine (HCQ) intake (p = 0.045). Risk factors of bilateral ONFH were the presence of serositis, nephritis, increased SLICC/DI and increased VAS-pain (p = 0.02, p = 0.03, p = 0.009 and p = 0.008, respectively). Conclusion: Nephritis, serositis, GI involvement, arthritis, steroids are key predictors for advanced ONFH while HCQ was protective. Risk factors for bilateral ONFH were serositis, nephritis, increased damage-index and VAS-pain. Keywords: Osteonecrosis, Systemic lupus erythematosus, SLEDAI, SLICC damage index, MRI, Egyptian