The frequency of avascular necrosis in juvenile systemic lupus erythematosus
Year 2020,
Volume: 45 Issue: 1, 200 - 207, 31.03.2020
Sibel Balcı
,
Rabia Miray Kışla Ekinci
,
Ferhat Can Pişkin
,
Engin Melek
Bahriye Atmış
,
Dilek Doğruel
Derya Ufuk Altıntaş
,
Aysun Karabay Bayazıt
Abstract
Purpose: Avascular necrosis (AVN) is a debilitating complication of juvenile systemic lupus erythematosus (jSLE). The aim of this study was to evaluate the frequency and clinical characteristics of patients with AVN in jSLE from a single center.
Material and Methods: Fifty-eight jSLE patients diagnosed according to the American College of Rheumatology classification criteria were included in this retrospective study. Disease activity of jSLE patients was measured by SLE Disease Activity Index-2K (SLEDAI-2K), organ damage was determined by the pediatric version of the systemic lupus international collaborating clinics/American College of Rheumatology damage index (pedSDI) at last visit.
Results: Among 58 jSLE patients, the female patients accounted for 86.2% (n=50). Mean baseline SLEDAI-2K score was 21.47±8.96. The number of patients with at least one damage item of pedSDI was 24 (41.4%), in which 5 patients (8.6%) had AVN. There were no statistical differences between the groups except baseline complement 3 (C3) level was significantly lower in patients with AVN.
Conclusion: Baseline low C3 level might be a predictor for AVN development in jSLE patients.There is unmet need for multicenter studies investigating possible risk factors of AVN in jSLE patients.
Supporting Institution
None
References
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- 2- Sahin S, Adrovic A, Barut K, Canpolat N, Ozluk Y, Kilicaslan I, et al. Juvenile systemic lupus erythematosus in Turkey: demographic, clinical and laboratory features with disease activity and outcome. Lupus 2018; 27: 514-519.
- 3- Hiraki LT, Benseler SM, Tyrrell PN, Harvey E, Hebert D, Silverman ED. Ethnic differences in pediatric systemic lupus erythematosus. J Rheumatol 2009; 36:2539–2546.
- 4- Artim-Esen B, Şahin S, Çene E, Şahinkaya Y, Barut K, Adrovic A, et al. Comparison of disease characteristics, organ damage, and survival in patients with juvenile-onset and adult-onset systemic lupus erythematosus in a combined cohort from 2 tertiary centers in Turkey. J Rheumatol 2017; 44: 619–625.
- 5- Ravelli A, Duarte-Salazar C, Buratti S, Reiff A, Bernstein B, Maldonado-Velazquez MR, et al. Assessment of damage in juvenile-onset systemic lupus erythematosus: a multicenter cohort study. Arthritis Rheum 2003; 49:501-507.
- 6- Ravelli A, Ruperto N, Martini A. Outcome in juvenile onset systemic lupus erythematosus. Curr Opin Rheumatol 2005; 17: 568-573.
- 7- Gutiérrez-Suárez R, Ruperto N, Gastaldi R, Pistorio A, Felici E, Burgos-Vargas R, et al. A proposal for a pediatric version of the systemic lupus international collaborating clinics/American College of Rheumatology damage index based on the analysis of 1,015 patients with juvenile-onset systemic lupus erythematosus. Arthritis Rheum 2006; 54: 2989–2996.
- 8- Castro TC, Lederman H, Terreri MT, Caldana WI, Kaste SC, Hilário MO. The use of joint-specific and whole-body MRI in osteonecrosis: a study in patients with juvenile systemic lupus erythematosus. Br J Radiol 2011; 84: 621-628.
- 9- Dubois EL, Cozen L. Avascular (aseptic) bone necrosis associated with systemic lupus erythematosus. JAMA 1960; 174:966-971.
- 10- Salah S, Lotfy HM, Mokbel AN, Kaddah AM, Fahmy N. Damage index in childhood-onset systemic lupus erythematosus in Egypt. Pediatr Rheumatol Online J 2011; 9:36.
- 11- Gurion R, Tangpricha V, Yow E, Schanberg LE, McComsey GA, Robinson AB, et al. Avascular necrosis in pediatric systemic lupus erythematosus: a brief report and review of the literature. Pediatr Rheumatol Online J 2015; 3: 13.
- 12- Yang Y, Kumar S, Lim LS, Silverman ED, Levy DM. Risk Factors for Symptomatic Avascular Necrosis in Childhood-onset Systemic Lupus Erythematosus. J Rheumatol 2015; 42: 2304-2309.
- 13- Ekinci RMK, Balcı S, Celik G, Dogruel D, Altıntas DU, Yilmaz M. Symptomatic multifocal avascular necrosis in an adolescent with neuropsychiatric systemic lupus erythematosus. Reumatologia 2019; 57: 182-187.
- 14- Bergstein JM, Wiens C, Fish AJ, Vernier RL, Michael A. Avascular necrosis of bone in systemic lupus erythematosus. J Pediatr 1974; 85: 31-35. 15- Gladman DD, Ibanez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol 2002; 29: 288–291.
- 16- Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40: 1725.
- 17- The American College of Rheumatology. Nomenclature and case definitions for neuropsychiatric lupus syndromes Arthritis Rheum 1999; 42: 599–608.
- 18- Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 2004; 15: 241–250.
- 19- Gutiérrez-Suárez R, Ruperto N, Gastaldi R, Pistorio A, Felici E, Burgos-Vargas R, et al. A proposal for a pediatric version of the systemic lupus international collaborating clinics/American College of Rheumatology damage index based on the analysis of 1,015 patients with juvenile-onset systemic lupus erythematosus. Arthritis Rheum 2006; 54: 2989–2996.
- 20- Hisada R, Kato M, Ohnishi N, Sugawara E, Fujieda Y, Oku K, et al. Antiphospholipid score is a novel risk factor for idiopathic osteonecrosis of the femoral head in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2019; 58: 645-649.
- 21- Kwon HH, Bang SY, Won S, Park Y, Yi JH, Joo YB, et al. Synergistic effect of cumulative corticosteroid dose and immunosuppressants on avascular necrosis in patients with systemic lupus erythematosus. Lupus 2018; 27: 1644-1651.
- 22- Petri MA, Conklin J, O'Malley T, Dervieux T. Platelet-bound C4d, low C3 and lupus anticoagulant associate with thrombosis in SLE. Lupus Sci Med 2019; 30; 6: e000318.
- 23- Magder LS, Petri M. Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupus erythematosus. Am J Epidemiol 2012; 15; 176: 708-719.
Çocukluk çağı başlangıçlı sistemik lupus eritematozus hastalarında avasküler nekrozis sıklığı
Year 2020,
Volume: 45 Issue: 1, 200 - 207, 31.03.2020
Sibel Balcı
,
Rabia Miray Kışla Ekinci
,
Ferhat Can Pişkin
,
Engin Melek
Bahriye Atmış
,
Dilek Doğruel
Derya Ufuk Altıntaş
,
Aysun Karabay Bayazıt
Abstract
Amaç: Avasküler nekrozis (AVN), çocukluk çağı başlangıçlı sistemik lupus eritematozusun (jSLE) yıkıcı bir komplikasyonudur. Tek merkezden yapılan bu çalışmanın amacı jSLE hastalarında AVN sıklığını ve bu hastaların klinik özelliklerini belirlemektir.
Gereç ve Yöntem: Amerikan Romatoloji Koleji’nin sınıflama kriterlerine göre tanı almış 58 jSLE hastası bu geriye dönük çalışmaya dahil edildi. jSLE hastalarının hastalık aktiviteleri SLE hastalık aktivite indeksi baz alınarak (SLEDAI-2K) ölçüldü. Organ hasarı Amerikan Romatoloji Koleji’nin SLE hastalarında uyguladığı hasar indeksinin çocukluklardaki versiyonu kullanılarak son muayenede belirlendi.
Bulgular: Elli sekiz jSLE hastasının %86,2 (50)’si kız hastaydı. Ortalama bazal SLEDAI-2K skoru 21,47±8,96 idi. En az bir organda hasarı olan hasta sayısı 24 (%41,4) idi, bunlardan 5 tanesinde (%8,6) AVN vardı. AVN olan ve olmayan hastalar arasında çeşitli değikenlere göre istatistiksel anlamlı bir farklılık saptanmadı. Sadece bazal kompleman 3 (C3) düzeyi AVN hastalarında, AVN olmayan hastalara göre anlamlı olarak düşüktü.
Sonuç: Bazal düşük C3 düzeyi jSLE hastalarında AVN gelişimini tahmin etmede ön görücü olabilir. jSLE hastalarında AVN gelişimi için muhtemel risk faktörlerini inceleyen çok merkezli çalışmalara ihtiyaç vardır.
References
- 1- Balci S, Ekinci RMK, Bayazit AK, Melek E, Dogruel D, Altintas DU, et al. Juvenile systemic lupus erythematosus: a single-center experience from southern Turkey. Clin Rheumatol 2019; 38:1459-1468.
- 2- Sahin S, Adrovic A, Barut K, Canpolat N, Ozluk Y, Kilicaslan I, et al. Juvenile systemic lupus erythematosus in Turkey: demographic, clinical and laboratory features with disease activity and outcome. Lupus 2018; 27: 514-519.
- 3- Hiraki LT, Benseler SM, Tyrrell PN, Harvey E, Hebert D, Silverman ED. Ethnic differences in pediatric systemic lupus erythematosus. J Rheumatol 2009; 36:2539–2546.
- 4- Artim-Esen B, Şahin S, Çene E, Şahinkaya Y, Barut K, Adrovic A, et al. Comparison of disease characteristics, organ damage, and survival in patients with juvenile-onset and adult-onset systemic lupus erythematosus in a combined cohort from 2 tertiary centers in Turkey. J Rheumatol 2017; 44: 619–625.
- 5- Ravelli A, Duarte-Salazar C, Buratti S, Reiff A, Bernstein B, Maldonado-Velazquez MR, et al. Assessment of damage in juvenile-onset systemic lupus erythematosus: a multicenter cohort study. Arthritis Rheum 2003; 49:501-507.
- 6- Ravelli A, Ruperto N, Martini A. Outcome in juvenile onset systemic lupus erythematosus. Curr Opin Rheumatol 2005; 17: 568-573.
- 7- Gutiérrez-Suárez R, Ruperto N, Gastaldi R, Pistorio A, Felici E, Burgos-Vargas R, et al. A proposal for a pediatric version of the systemic lupus international collaborating clinics/American College of Rheumatology damage index based on the analysis of 1,015 patients with juvenile-onset systemic lupus erythematosus. Arthritis Rheum 2006; 54: 2989–2996.
- 8- Castro TC, Lederman H, Terreri MT, Caldana WI, Kaste SC, Hilário MO. The use of joint-specific and whole-body MRI in osteonecrosis: a study in patients with juvenile systemic lupus erythematosus. Br J Radiol 2011; 84: 621-628.
- 9- Dubois EL, Cozen L. Avascular (aseptic) bone necrosis associated with systemic lupus erythematosus. JAMA 1960; 174:966-971.
- 10- Salah S, Lotfy HM, Mokbel AN, Kaddah AM, Fahmy N. Damage index in childhood-onset systemic lupus erythematosus in Egypt. Pediatr Rheumatol Online J 2011; 9:36.
- 11- Gurion R, Tangpricha V, Yow E, Schanberg LE, McComsey GA, Robinson AB, et al. Avascular necrosis in pediatric systemic lupus erythematosus: a brief report and review of the literature. Pediatr Rheumatol Online J 2015; 3: 13.
- 12- Yang Y, Kumar S, Lim LS, Silverman ED, Levy DM. Risk Factors for Symptomatic Avascular Necrosis in Childhood-onset Systemic Lupus Erythematosus. J Rheumatol 2015; 42: 2304-2309.
- 13- Ekinci RMK, Balcı S, Celik G, Dogruel D, Altıntas DU, Yilmaz M. Symptomatic multifocal avascular necrosis in an adolescent with neuropsychiatric systemic lupus erythematosus. Reumatologia 2019; 57: 182-187.
- 14- Bergstein JM, Wiens C, Fish AJ, Vernier RL, Michael A. Avascular necrosis of bone in systemic lupus erythematosus. J Pediatr 1974; 85: 31-35. 15- Gladman DD, Ibanez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol 2002; 29: 288–291.
- 16- Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40: 1725.
- 17- The American College of Rheumatology. Nomenclature and case definitions for neuropsychiatric lupus syndromes Arthritis Rheum 1999; 42: 599–608.
- 18- Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 2004; 15: 241–250.
- 19- Gutiérrez-Suárez R, Ruperto N, Gastaldi R, Pistorio A, Felici E, Burgos-Vargas R, et al. A proposal for a pediatric version of the systemic lupus international collaborating clinics/American College of Rheumatology damage index based on the analysis of 1,015 patients with juvenile-onset systemic lupus erythematosus. Arthritis Rheum 2006; 54: 2989–2996.
- 20- Hisada R, Kato M, Ohnishi N, Sugawara E, Fujieda Y, Oku K, et al. Antiphospholipid score is a novel risk factor for idiopathic osteonecrosis of the femoral head in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2019; 58: 645-649.
- 21- Kwon HH, Bang SY, Won S, Park Y, Yi JH, Joo YB, et al. Synergistic effect of cumulative corticosteroid dose and immunosuppressants on avascular necrosis in patients with systemic lupus erythematosus. Lupus 2018; 27: 1644-1651.
- 22- Petri MA, Conklin J, O'Malley T, Dervieux T. Platelet-bound C4d, low C3 and lupus anticoagulant associate with thrombosis in SLE. Lupus Sci Med 2019; 30; 6: e000318.
- 23- Magder LS, Petri M. Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupus erythematosus. Am J Epidemiol 2012; 15; 176: 708-719.