Predictive factors for symptomatic osteonecrosis in patients with systemiclupus erythematosus

Objective. To analyze predictive factors for the development of osteonecros is (ON) in a large cohort of patients with systemic lupus erythematosus (SL E) followed in a single center, Methods. A nested matched case control design was used. Patients with SLE w ho developed ON during followup were identified from the University of Toro nto Lupus Clinic database, The diagnosis of ON was confirmed by either radi ographs, bent: scans, tomograms, or magnetic resonance imaging, A compariso n group of patients with SLE without ON was elected from the same database, matched by year of birth, sex, and year of entry to the clinic to the pati ents with ON. Clinical, laboratory, and therapeutic factors thought to be r elevant to the development of ON were compared between the 2 groups, Results. Seventy patients with SLE developed ON in the course of followup a t the clinic, In univariate analysis. arthritis was the only clinical featu re predictive of the: development of ON. Use of glucocorticosteroid therapy , dose and duration, as well as Cushingoid appearance and cytotoxic therapy were also predictive for the development of ON. Multivariate analysis reve aled that glucocorticosteroid use, the: presence of arthritis, and the use of cytotoxic medications remained significant. Conclusion. Glucocorticosteroid therapy, the presence of arthritis, and use of cytotoxic medication are independent risk factors For development of ON in patients with SLE.