Predictors of avascular necrosis in a cohort of Egyptian systemic lupus erythematosus patients: Retrospective two centers study

Abstract

Background: Avascular necrosis is a common complication in patients with SLE. Objective: This study aimed to investigate the risk factors for occurrence of avascular necrosis among SLE patients receiving steroid therapy at various doses, in combination with immunosuppressants. Methods: In this retrospective study, the medical records of all SLE patients under follow-up at the outpatient clinics of Cairo and kafr Elsheikh University hospitals through the period from November 2014 to August 2019, were included. The avascular necrosis was diagnosed by the findings of different imaging modalities. Results: We retrieved the medical records of 770 SLE patients during the study period; of them, 55 patients (7.1%) had avascular necrosis. There was significant higher usage of cyclophosphamide (p = 0.003), total cumulative dose of steroids 15-35g plus immunosuppressants (p < 0.001), and steroids >35g plus Immunosuppressants (p = 0.016) in avascular necrosis cohort. Based on the univariate analysis, disease duration more than five years and cumulative use of steroids were statistically significant predictors for the evolvement of avascular necrosis. Multivariate logistic regression analysis revealed that disease duration more than five years was associated independently with avascular necrosis. Conclusion: Our data seem to show a role of the association of immunosuppressant plus steroid on the risk to develop avascular necrosis.