Corticosteroid Use Linked to Risk for Osteonecrosis in Systemic Lupus Erythematosus

osteonecrosis x-ray
osteonecrosis x-ray
Investigators sought to identify the risk factors for osteonecrosis and to identify the minimal investigations needed to monitor the risk for osteonecrosis in patients with systemic lupus erythematosus.

Corticosteroid use among patients with systemic lupus erythematosus (SLE) may be a strong risk factor for the development of osteonecrosis (ON), according to the results of a systematic review and meta-analysis published in The Journal of Rheumatology.

The investigators included a total of 50 studies in their final analysis. Of the studies selected, most (46 of 50) were case-control types. The aim of this analysis was to determine the risk factors associated with ON, which is known to be a key complication among patients with SLE. Risk factors for ON among patients with SLE were compiled.

Average daily use of corticosteroid, highest dose of corticosteroid used, total cumulative corticosteroid dose, pulse therapy, and Cushingoid appearance were all linked to ON. The quality of the evidence was low to very low, however, because of the high risk for bias and frequent inconsistency across studies, reducing the ability to draw strong conclusions. The quality of each study selected for analysis was evaluated using the Newcastle-Ottawa scale for nonrandomized studies, and the quality of evidence for each risk factor was evaluated with the Grading of Recommendations, Assessment, Development, and Evaluation method.

Corticosteroid use was identified as being strongly associated with ON in patients with SLE. Other clinical variables that were moderately associated with ON among individuals with SLE included hypertension, renal disease, serositis, arthritis, vasculitis, central nervous system disease, and neuropsychiatric manifestations of SLE.

Related Articles

According to the investigators, the results of this review were considered in the development of recommendations for the diagnosis and monitoring of patients with SLE in Canada and will help to guide clinicians in their evaluation of these patients. Healthcare professionals should maintain a high index of suspicion for ON among patients with SLE, particularly in the presence of known risk factors such as corticosteroid use.

follow @RheumAdvisor


Hussein S, Suitner M, Béland-Bonenfant S, et al. Monitoring of osteonecrosis in systemic lupus erythematosus patients: a systematic review and metaanalysis [published online July 1, 2018]. J Rheumatol. doi: 10.3899/jrheum.170837