title: Non-corticosteroid risk factors of symptomatic avascular necrosis of bone in systemic lupus erythematosus: A retrospective case-control study.
abstract: OBJECTIVE
  Avascular necrosis of bone (AVN) is an important complication of systemic lupus erythematosus (SLE). Corticosteroid therapy has been underlined as a main risk factor for osteonecrosis. However, AVN development in patients who have never received corticosteroid and the absence of AVN in the majority of the patients, who received corticosteroid, propose a role for non-corticosteroid risk factors in AVN development.
  
  
  METHODS
  This case-control study included two subsets: oral corticosteroid (66 AVN and 248 non-AVN patients) and pulse-therapy subset (39 AVN and 312 non-AVN patients) who have attended our Lupus clinic from 1979 to 2009. Patients received similar cumulative dose corticosteroid, equal maximum dose and 1-year maximum dose of corticosteroid. The demographic data (including sex, age of disease onset, age at the diagnosis of AVN), organs involvement, SLE Disease Activity Index (SLEDAI), Systemic Lupus International Collaborating Clinics/American College of Rheumatology-Damage index (SLICC/ACR-DI), number of disease flare ups were compared between two subsets.
  
  
  RESULTS
  The mean age of SLE onset was younger (P value = 0.04) in the AVN patients. In oral corticosteroid subset, malar rash (P value < 0.001) and oral ulcer (P value = 0.003) were seen more frequently in non-AVN patients, whereas psychosis (P value = 0.03) was significantly more prevalent AVN subset in oral corticosteroid subset. In corticosteroid pulse subset, no significant difference in clinical features was noted.
  
  
  CONCLUSIONS
  In oral corticosteroid subset, younger age of disease onset and psychosis were significantly associated with AVN, whereas malar rash and oral ulcer showed negative association AVN.
authors.affiliation: Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Seyedeh Tahereh
authors.initials: ST
authors.lastname: Faezi
authors.forename: Azam Sadat
authors.initials: AS
authors.lastname: Hoseinian
authors.forename: Pedram
authors.initials: P
authors.lastname: Paragomi
authors.forename: Mahmood
authors.initials: M
authors.lastname: Akbarian
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Esfahanian
authors.forename: Farhad
authors.initials: F
authors.lastname: Gharibdoost
authors.forename: Maassoumeh
authors.initials: M
authors.lastname: Akhlaghi
authors.forename: Abdolhadi
authors.initials: A
authors.lastname: Nadji
authors.forename: Ahmad Reza
authors.initials: AR
authors.lastname: Jamshidi
authors.forename: Farhad
authors.initials: F
authors.lastname: Shahram
authors.forename: Mohammad
authors.initials: M
authors.lastname: Nejadhosseinian
authors.forename: Fereydoun
authors.initials: F
authors.lastname: Davatchi
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008297:Male; D010020:Osteonecrosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D005938:Glucocorticoids
keywords: Avascular necrosis; Systemic lupus erythematosus