title: Outcomes of symptomatic osteonecrosis in 95 patients with systemic lupus erythematosus.
abstract: OBJECTIVE
  To describe the frequency and type of symptomatic osteonecrosis (ON) in a large cohort of patients with systemic lupus erythematosus (SLE) followed in a single center and to describe the outcome in terms of mortality and disability compared to SLE patients without ON.
  
  
  METHODS
  Patients with ON were identified from the University of Toronto Lupus Clinic Database. The diagnosis of ON was confirmed by radiographs, bone scans, tomograms, or magnetic resonance images. A comparison group of patients with SLE without ON was selected from the same database, matched by year of birth, sex, and year of entry to the clinic. Mortality, disability, and health related quality of life were compared between patients with and without ON.
  
  
  RESULTS
  Ninety-nine patients with ON were identified with 217 affected joints, the majority hips and knees, often in a bilateral distribution. There was no increase in mortality. Patients with ON had higher Health Assessment Questionnaire scores and lower SF-20 scores of physical functioning, suggesting increased disability. Hip joints that underwent surgery were more likely to have higher grades of ON at diagnosis.
  
  
  CONCLUSIONS
  Symptomatic ON occurred in 12.8% of 744 patients with SLE and often involved multiple joints. ON was not associated with increased mortality but was associated with physical disability. Radiological class of the hip jointsat diagnosis of ON was predictive of subsequent surgery.
authors.affiliation: University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital, Ontario, Canada. dafna.gladman@utoronto.ca
authors.forename: D D
authors.initials: DD
authors.lastname: Gladman
authors.forename: V
authors.initials: V
authors.lastname: Chaudhry-Ahluwalia
authors.forename: D
authors.initials: D
authors.lastname: Ibañez
authors.forename: E
authors.initials: E
authors.lastname: Bogoch
authors.forename: M B
authors.initials: MB
authors.lastname: Urowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000401:mortality* / Q000601:surgery; D011379:Prognosis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents