Clinical features and factors associated with osteonecrosis in childhood-onset systemic lupus erythematosus
10.3760/cma.j.issn.2095-428X.2019.21.005
- VernacularTitle: 儿童系统性红斑狼疮并发骨梗死的临床特点及相关因素分析
- Author:
Sang CHENG
1
;
Lanfang CAO
;
Yanming LU
Author Information
1. Department of Pediatrics, Renji Hospital Affiliated to School of Medicine of Shanghai Jiaotong University, Shanghai 200001, China
- Publication Type:Journal Article
- Keywords:
Child;
Systemic lupus erythematosus;
Osteonecrosis;
Features;
Risk factors
- From:
Chinese Journal of Applied Clinical Pediatrics
2019;34(21):1618-1622
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical features and factors associated with osteonecrosis in children with systemic lupus erythematosus (SLE).
Methods:A retrospective analysis of 15 SLE patients with osteonecrosis in Department of Pediatrics, Renji Hospital Affiliated to School of Medicine of Shanghai Jiaotong University from January 2013 to May 2017 was carried out.Forty-two SLE patients without osteonecrosis were selected as control group.The clinical, laboratory variables and the treatment were compared among SLE patients who were with and without osteonecrosis.
Results:(1) Fifteen patients developed osteonecrosis that constituted 8.6% of all the 175 hospitalized SLE patients during the same period.(2) Of 15 patients, 2 patients were male, 13 patients were female, who developed osteonecrosis with an average age of (13.9±2.7) years (range: 10-18 years old). The duration of SLE before the diagnosis of osteonecrosis ranged from 6 days to 141 months, the median was 10 months, and 80.0% (12/15 cases) was diagnosed with osteonecrosis within 2 years of SLE diagnosis.There were 36 joints involved in 15 patients, all of which were detected by magnetic resonance imaging(MRI). The knees were the most commonly involved joints(14/15 cases, 93.3%), followed by hip and ankle joints.(3) Univariate analysis revealed that the level of Triglyceride [(2.080±1.500) mmol/L vs.(1.350±0.945) mmol/L], maximum daily dose of glucocorticoid[(1.25±0.33) mg/kg vs.(1.07±0.22) mg/kg], positive rate of gene associated with glucocorticoid-induced osteonecrosis of femoral head(100.0% vs.54.8%)were significantly higher in SLE with osteonecrosis than those in controls(all P<0.05). While the level of 25(OH)D3[(21.37±11.29) μg/L vs.(31.45±17.73) μg/L] was significantly lower than that of controls(P<0.05). Multiple factor Logistic regression analysis showed that hypertriglyceridemia and daily maximum dose of glucocorticoid were the risk factors for osteonecrosis.
Conclusions:Osteonecrosis mostly occurred in children over 10 years old, knee joint involvement is the most common.The high-risk time of osteonecrosis is within 2 years of SLE diagnosis.Hypertriglyceridemia and daily ma-ximum dose of glucocorticoid are risk factors associated with osteonecrosis in children with SLE.
