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Transitional changes in the incidence of osteonecrosis in systemic lupus erythematosus patients: focus on immunosuppressant agents and glucocorticoids

Abstract Objective The purpose of this study was to investigate transitional changes in the incidence of glucocorticoid-associated osteonecrosis in SLE patients, with a focus on immunosuppressive agent and glucocorticoid consumption. Methods We retrospectively registered 185 SLE patients with 740 jo... Full description

Journal Title: Rheumatology 2018, Vol. 57(5), pp.844-849
Main Author: Nawata, Kento
Other Authors: Nakamura, Junichi , Ikeda, Kei , Furuta, Shunsuke , Nakajima, Hiroshi , Ohtori, Seiji , Hagiwara, Shigeo , Wako, Yasushi , Miura, Michiaki , Kawarai, Yuya , Sugano, Masahiko , Yoshino, Kensuke , Orita, Sumihisa , Inage, Kazuhide , Akazawa, Tsutomu
Format: Electronic Article Electronic Article
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Subjects:
Sle
Mri
ID: ISSN: 1462-0324 ; E-ISSN: 1462-0332 ; DOI: 10.1093/rheumatology/key009
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recordid: oxford10.1093/rheumatology/key009
title: Transitional changes in the incidence of osteonecrosis in systemic lupus erythematosus patients: focus on immunosuppressant agents and glucocorticoids
format: Article
creator:
  • Nawata, Kento
  • Nakamura, Junichi
  • Ikeda, Kei
  • Furuta, Shunsuke
  • Nakajima, Hiroshi
  • Ohtori, Seiji
  • Hagiwara, Shigeo
  • Wako, Yasushi
  • Miura, Michiaki
  • Kawarai, Yuya
  • Sugano, Masahiko
  • Yoshino, Kensuke
  • Orita, Sumihisa
  • Inage, Kazuhide
  • Akazawa, Tsutomu
subjects:
  • Systemic Lupus Erythematosus
  • Sle
  • Osteonecrosis
  • Glucocorticoids
  • Immunosuppressant
  • Calcineurin Inhibitors
  • Mri
ispartof: Rheumatology, 2018, Vol. 57(5), pp.844-849
description: Abstract Objective The purpose of this study was to investigate transitional changes in the incidence of glucocorticoid-associated osteonecrosis in SLE patients, with a focus on immunosuppressive agent and glucocorticoid consumption. Methods We retrospectively registered 185 SLE patients with 740 joints, who were newly diagnosed and hospitalized for initial high-dose glucocorticoid therapy from 1986 to 2015. Immunosuppressive agent, glucocorticoid dose, age, sex, organ lesion at hospitalization, complement (C3, C4, CH50) and anti-DNA antibody before initial glucocorticoid therapy, the frequency of use of anticoagulant and antilipidemic drugs, and incidence of osteonecrosis were documented. Results Based on trends in immunosuppressive agent use, 116 patients treated from 1986 to 1999, before calcineurin inhibitors were introduced, comprised the past group, and 69 patients treated from 2000 to 2015 comprised the recent group. Patient characteristics (age, sex and organ lesion at hospitalization, complement, anti-DNA antibody, the frequency of use of anticoagulant and antilipidemic drugs) were similar between groups. Glucocorticoid doses were significantly lower in the recent group than in the past group (highest daily glucocorticoid dose, 45.7 vs 59.0 mg/day, respectively; dose per weight, 0.88 vs 1.16 mg/day/kg, respectively; and cumulative dose at 3 months, 3118 vs 3985 mg). The incidence of osteonecrosis was significantly lower in the recent group than in the past group (26.4 vs 41.0%, respectively), particularly in the knee (25.4 vs 46.6%, respectively). Conclusion The incidence of glucocorticoid-associated osteonecrosis in SLE patients decreased in association with a decrease in glucocorticoid administration after introduction of immunosuppressant agents.
language:
source:
identifier: ISSN: 1462-0324 ; E-ISSN: 1462-0332 ; DOI: 10.1093/rheumatology/key009
fulltext: fulltext
issn:
  • 1462-0324
  • 14620324
  • 1462-0332
  • 14620332
url: Link


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titleTransitional changes in the incidence of osteonecrosis in systemic lupus erythematosus patients: focus on immunosuppressant agents and glucocorticoids
creatorNawata, Kento ; Nakamura, Junichi ; Ikeda, Kei ; Furuta, Shunsuke ; Nakajima, Hiroshi ; Ohtori, Seiji ; Hagiwara, Shigeo ; Wako, Yasushi ; Miura, Michiaki ; Kawarai, Yuya ; Sugano, Masahiko ; Yoshino, Kensuke ; Orita, Sumihisa ; Inage, Kazuhide ; Akazawa, Tsutomu
ispartofRheumatology, 2018, Vol. 57(5), pp.844-849
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subjectSystemic Lupus Erythematosus ; Sle ; Osteonecrosis ; Glucocorticoids ; Immunosuppressant ; Calcineurin Inhibitors ; Mri
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descriptionAbstract Objective The purpose of this study was to investigate transitional changes in the incidence of glucocorticoid-associated osteonecrosis in SLE patients, with a focus on immunosuppressive agent and glucocorticoid consumption. Methods We retrospectively registered 185 SLE patients with 740 joints, who were newly diagnosed and hospitalized for initial high-dose glucocorticoid therapy from 1986 to 2015. Immunosuppressive agent, glucocorticoid dose, age, sex, organ lesion at hospitalization, complement (C3, C4, CH50) and anti-DNA antibody before initial glucocorticoid therapy, the frequency of use of anticoagulant and antilipidemic drugs, and incidence of osteonecrosis were documented. Results Based on trends in immunosuppressive agent use, 116 patients treated from 1986 to 1999, before calcineurin inhibitors were introduced, comprised the past group, and 69 patients treated from 2000 to 2015 comprised the recent group. Patient characteristics (age, sex and organ lesion at hospitalization, complement, anti-DNA antibody, the frequency of use of anticoagulant and antilipidemic drugs) were similar between groups. Glucocorticoid doses were significantly lower in the recent group than in the past group (highest daily glucocorticoid dose, 45.7 vs 59.0 mg/day, respectively; dose per weight, 0.88 vs 1.16 mg/day/kg, respectively; and cumulative dose at 3 months, 3118 vs 3985 mg). The incidence of osteonecrosis was significantly lower in the recent group than in the past group (26.4 vs 41.0%, respectively), particularly in the knee (25.4 vs 46.6%, respectively). Conclusion The incidence of glucocorticoid-associated osteonecrosis in SLE patients decreased in association with a decrease in glucocorticoid administration after introduction of immunosuppressant agents.
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titleTransitional changes in the incidence of osteonecrosis in systemic lupus erythematosus patients: focus on immunosuppressant agents and glucocorticoids
authorNawata, Kento ; Nakamura, Junichi ; Ikeda, Kei ; Furuta, Shunsuke ; Nakajima, Hiroshi ; Ohtori, Seiji ; Hagiwara, Shigeo ; Wako, Yasushi ; Miura, Michiaki ; Kawarai, Yuya ; Sugano, Masahiko ; Yoshino, Kensuke ; Orita, Sumihisa ; Inage, Kazuhide ; Akazawa, Tsutomu
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atitleTransitional changes in the incidence of osteonecrosis in systemic lupus erythematosus patients: focus on immunosuppressant agents and glucocorticoids
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