Advertisement

Rheumatology International

, Volume 30, Issue 12, pp 1587–1593 | Cite as

Investigation of occurrence of osteonecrosis of the femoral head after increasing corticosteroids in patients with recurring systemic lupus erythematosus

  • Fumio SekiyaEmail author
  • Ken Yamaji
  • Kwangseok Yang
  • Hiroshi Tsuda
  • Yoshinari Takasaki
Original Article

Abstract

Osteonecrosis (ON) of the femoral head is known to occur commonly in cases with systemic lupus erythematosus (SLE) that received corticosteroid (CS) treatment. However, there have been no detailed reports about the onset of ON in cases with recurrence of SLE. Using MRI, we followed up 17 patients who experienced recurrence of SLE for at least 1 year at our hospital and in whom the CS dose was increased from a maintenance dose to middle to high dose to see if ON would occur. We then compared the group that developed ON and the group that did not with respect to patient characteristics, blood test results, changes in serum lipid levels, and CS dose. ON occurred in five subjects (29.4%), revealing that osteonecrosis occurs not only when CS are first administered but also in cases which the CS dose is increased for recurrence of SLE. Especially, serum cholesterol levels and its rate of increase soared rapidly soon after increasing the CS dose in the ON group as compared with the non-ON group (P < 0.05). This suggests that increased serum lipid levels might be a contributing factor to onset of ON. Moreover, SLE disease activity index 2000 (SLEDAI-2K) scores when the CS dose was increased were significantly (P < 0.05) higher in the ON group, suggesting that SLE disease activity itself is a risk factor for onset of ON.

Keywords

Osteonecrosis SLE Corticosteroid Lipid Risk factor 

Notes

Acknowledgment

This study was conducted as part of a research project for overcoming refractory disorders commissioned by the Ministry of Health, Labour and Welfare of Japan.

References

  1. 1.
    Moskal JT, Topping RE, Franklin LL (1997) Hypercholesterolemia: an association with osteonecrosis of the femoral head. Am J Orthop 26:609–612PubMedGoogle Scholar
  2. 2.
    Oinuma K, Harada Y, Nawata Y et al (2000) Sustained hemostatic abnormality in patients with steroid-induced osteonecrosis in the early period after high-dose corticosteroid therapy. J Orthop Sci 5:374–379CrossRefPubMedGoogle Scholar
  3. 3.
    Iuchi T, Akaike M, Mitsui T et al (2003) Glucocorticoid excess induces superoxide production in vascular endothelial cells and elicits vascular endothelial dysfunction. Circ Res 92:81–87CrossRefPubMedGoogle Scholar
  4. 4.
    Klippel JH, Gerber LH, Pollak L, Decker JL (1979) Avascular necrosis in systemic lupus erythematosus. Silent symmetric osteonecroses. Am J Med 67:83–87CrossRefPubMedGoogle Scholar
  5. 5.
    Ono K, Tohjima T, Komazawa T (1992) Risk factors of avascular necrosis of the femoral head in patients with systemic lupus erythematosus under high-dose corticosteroid therapy. Clin Orthop Relat Res 277:89–97PubMedGoogle Scholar
  6. 6.
    Migliaresi S, Picillo U, Ambrosone L et al (1994) Avascular osteonecrosis in patients with SLE: relation to corticosteroid therapy and anticardiolipin antibodies. Lupus 3:37–41CrossRefPubMedGoogle Scholar
  7. 7.
    Mont MA, Glueck CJ, Pacheco IH et al (1997) Risk factors for osteonecrosis in systemic lupus erythematosus. J Rheumatol 24:654–662PubMedGoogle Scholar
  8. 8.
    Mok CC, Lau CS, Wong RW (1998) Risk factors for avascular bone necrosis in systemic lupus erythematosus. Br J Rheumatol 37:895–900CrossRefPubMedGoogle Scholar
  9. 9.
    Sakamoto M, Shimizu K, Iida S et al (1997) Osteonecrosis of the femoral head: a prospective study with MRI. J Bone Joint Surg Br 79:213–219CrossRefPubMedGoogle Scholar
  10. 10.
    Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus [letter]. Arthritis Rheum 40:1725CrossRefPubMedGoogle Scholar
  11. 11.
    Gladman DD, Ibañez D, Urowitz MB (2002) Systemic lupus erythematosus disease activity index 2000. J Rheumatol 29:288–291PubMedGoogle Scholar
  12. 12.
    Fukushima W et al (2007) In: Kubo T (ed) The general study aimed for standardization of the prevention and the treatment of the idiopathic osteonecrosis of the femoral head. Research Group of the idiopathic osteonecrosis of the femoral head, Ministry of Health, Labor, and Welfare of Japan. pp 7–11 (in Japanese)Google Scholar
  13. 13.
    Hirota Y, Hirohata T, Fukuda K et al (1993) Association of alcohol intake, cigarette smoking, and occupational status with the risk of idiopathic osteonecrosis of the femoral head. Am J Epidemiol 137:530–538PubMedGoogle Scholar
  14. 14.
    Matsuo K, Hirohata T, Sugioka Y et al (1988) Influence of alcohol intake, cigarette smoking, and occupational status on idiopathic osteonecrosis of the femoral head. Clin Orthop Relat Res 234:115–123PubMedGoogle Scholar
  15. 15.
    Mont MA, Jones LC, Hungerford DS (2006) Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg Am 88:1117–1132 ReviewCrossRefPubMedGoogle Scholar
  16. 16.
    Agarwala S, Jain D, Joshi VR et al (2005) Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip. A prospective open-label study. Rheumatology (Oxford) 44:352–359CrossRefGoogle Scholar
  17. 17.
    Lai KA, Shen WJ, Yang CY et al (2005) The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am 87:2155–2159CrossRefPubMedGoogle Scholar
  18. 18.
    Nishii T, Sugano N, Miki H et al (2006) Does alendronate prevent collapse in osteonecrosis of the femoral head? Clin Orthop Relat Res 443:273–279CrossRefPubMedGoogle Scholar
  19. 19.
    Cui Q, Wang GJ, Su CC et al (1997) Lovastatin prevents steroid induced adipogenesis and osteonecrosis. Clin Orthop Relat Res 344:8–19CrossRefPubMedGoogle Scholar
  20. 20.
    Pritchett JW (2001) Statin therapy decreases the risk of osteonecrosis in patients receiving steroids. Clin Orthop Relat Res 386:173–178CrossRefPubMedGoogle Scholar
  21. 21.
    Nagasawa K, Tada Y, Koarada S et al (2005) Very early development of steroid-associated osteonecrosis of femoral head in systemic lupus erythematosus: prospective study by MRI. Lupus 14:385–390CrossRefPubMedGoogle Scholar
  22. 22.
    Miyanishi K, Yamamoto T, Irisa T et al (2001) A high low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a potential risk factor for corticosteroid-induced osteonecrosis in rabbits. Rheumatology (Oxford) 40:196–201CrossRefGoogle Scholar
  23. 23.
    Lafforgue P (2006) Pathophysiology and natural history of avascular necrosis of bone. Joint Bone Spine 73:500–507 ReviewCrossRefPubMedGoogle Scholar
  24. 24.
    Massardo L, Jacobeli S, Leissner M et al (1992) High-dose intravenous methylprednisolone therapy associated with osteonecrosis in patients with systemic lupus erythematosus. Lupus 1:401–405CrossRefPubMedGoogle Scholar
  25. 25.
    Asano T, Takahashi KA, Fujioka M et al (2003) ABCB1 C3435T and G2677T/A polymorphism decreased the risk for steroid-induced osteonecrosis of the femoral head after kidney transplantation. Pharmacogenetics 13:675–682CrossRefPubMedGoogle Scholar
  26. 26.
    Hirata T, Fujioka M, Takahashi KA et al (2007) ApoB C7623T polymorphism predicts risk for steroid-induced osteonecrosis of the femoral head after renal transplantation. J Orthop Sci 12:199–206CrossRefPubMedGoogle Scholar
  27. 27.
    Fialho SC, Bonfá E, Vitule LF et al (2007) Disease activity as a major risk factor for osteonecrosis in early systemic lupus erythematosus. Lupus 16:239–244CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Fumio Sekiya
    • 1
    Email author
  • Ken Yamaji
    • 1
  • Kwangseok Yang
    • 2
  • Hiroshi Tsuda
    • 2
  • Yoshinari Takasaki
    • 1
  1. 1.Department of Internal Medicine and RheumatologyJuntendo University School of MedicineTokyoJapan
  2. 2.Department of General Internal MedicineJuntendo Tokyo Koto Geriatric Medical CenterTokyoJapan

Personalised recommendations