Systemic Lupus Erythematosus and Osteonecrosis: A Comparison of
Patients with Single versus Multiple Joint Involvement
Tanaz A. Kermani*, 1, Cynthia S. Crowson2, Kimberly K. Amrami3, Daniel J. Berry 4, Kevin G. Moder*, 1
1 Division of Rheumatology, Department of Medicine, Mayo Clinic, USA
2 Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, USA
3 Department of Radiology, Mayo Clinic, USA
4 Department of Orthopedic Surgery, Mayo Clinic, USA
The purpose of this study was to determine the clinical and laboratory features associated with osteonecrosis of multiple (>/= 3) joints in systemic lupus erythematosus (SLE).
We included all patients with SLE and osteonecrosis evaluated at our institution between January 1, 2000 and June 30, 2006. The patients were divided into three groups based on osteonecrosis of 1 joint, 2 joints and 3 or more joints. Clinical features, laboratory findings and therapies of patients in these groups were compared using Fischer’s exact test and rank sum tests.
Our study included 4 men and 37 women. Twelve patients (29.3%) had osteonecrosis of 1 joint, 16 patients (39%) had osteonecrosis of 2 joints and 13 patients (31.7%) had osteonecrosis of 3 or more joints. The only clinical feature of SLE significantly associated with osteonecrosis of 3 or more joints was central nervous system (CNS) disease (p = 0.01). The median cumulative and peak corticosteroid doses were similar in all 3 groups (p = 0.70 and p = 0.11 respectively). There were no differences in the frequency of anti-cardiolipin antibodies.
History of CNS disease was the only variable associated with multiple joint osteonecrosis in patients with SLE. We found no association between corticosteroid doses and multiple joint osteonecrosis.
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