title: High triglyceride is a risk factor for silent osteonecrosis of the femoral head in systemic lupus erythematosus.
abstract: The purpose of this study was to clarify the factors related to silent osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE). Seventy-eight patients with SLE were selected on the basis of having been newly diagnosed and requiring high-dose prednisolone, including pulse therapy with methylprednisolone, as the initial treatment. All the patients initially underwent MRI at 3 months after the start of corticosteroid treatment to detect any early changes in the femoral head. These examinations were then performed again 3 months later. Laboratory parameters were evaluated at the start of steroid treatment and at 1 month thereafter. By 3 months after the start of corticosteroid treatment, silent ONFH was diagnosed by MRI in 21 patients (26.9 %), being bilateral in 11 patients and unilateral in 10. The occurrence of silent ONFH was not related to SLE disease activity index, serological activity, or renal function; it was also unrelated to body mass index (BMI), body surface area (BSA), and the initial dose of prednisolone per unit body weight. However, the total cholesterol level at 4 weeks after the start of steroid treatment tended to be higher in patients with silent ONFH. Patients with a higher triglyceride level showed a significantly higher frequency of silent ONFH both before (p = 0.002) and 4 weeks after (p = 0.036) steroid initiation.A high triglyceride level is an important risk factor for silent ONFH in patients with SLE, and large-scale epidemiologic surveys of such early events are needed in this patient population.
authors.affiliation: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan. kurodat@med.niigata-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kuroda
authors.affiliation: Department of Health and Nutrition, Faculty of Human Life Studies, University of Niigata Prefecture, 471 Ebigase, Higashi-ku, Niigata, 950-8680, Japan. tanabena@gmail.com.
authors.forename: Naohito
authors.initials: N
authors.lastname: Tanabe
authors.affiliation: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan. a.sohma0@gmail.com.
authors.forename: Ayako
authors.initials: A
authors.lastname: Wakamatsu
authors.affiliation: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan. chinatsunachi.89@gmail.com.
authors.forename: Chinatsu
authors.initials: C
authors.lastname: Takai
authors.affiliation: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan. hiroe77212@hotmail.com.
authors.forename: Hiroe
authors.initials: H
authors.lastname: Sato
authors.affiliation: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan. takeshinakatsue@gmail.com.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatsue
authors.affiliation: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan. yoko.wada@gmail.com.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Wada
authors.affiliation: Department of Medical Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8518, Japan. manakano@clg.niigata-u.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan. naritai@med.niigata-u.ac.jp.
authors.forename: Ichiei
authors.initials: I
authors.lastname: Narita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D015992:Body Mass Index; D001830:Body Surface Area; D005260:Female; D005271:Femur Head Necrosis / Q000097:blood / Q000453:epidemiology* / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000453:epidemiology*; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D014280:Triglycerides; D011239:Prednisolone; D008775:Methylprednisolone
keywords: Magnetic resonance imaging; Osteonecrosis of the femoral head; Steroid; Systemic lupus erythematosus; Triglyceride