الفهرس 
SYSTEMIC LUPUS ERYTHEMATOSUSOnly 14 pages are availabe for public view
 |  | from | 201 |  |  |
| | | from | 201 | | |
Abstract
S
ystemic Lupus Erythematosus is an inflammatory connective tissue disease with variable manifestations. SLE may affect many systems with immune complexes and a large array of auto antibodies, particularly anti nuclear anti bodies.
Avascular necrosis is a pathological state with a number of possible etiologies including steroid administration, alcohol abuse, traumatic events, vascular injury and idiopathic origins. AVN is characterized by areas of dead trabecular bone and marrow that extend to involve the subchondral plate. Typically, the principal weight bearing region, the anterolateral aspect of the femoral head is involved, but any region of the femoral head may be involved.
AVN is a well-recognized musculoskeletal complication of SLE and cause significant morbidity. Steroid therapy and the underlying disease process are major contributors to this complication and the degree to which each influences the development of AVN is unclear.
The present study was designed to evaluate the predictive factors for Osteonecrosis in SLE patients.
This study included (60) SLE patients who fulfilled the SLICC criteria for SLE classification. The patients were recruited from the outpatient clinic and the inpatient department of Rheumatology Ain Shams University Hospital. These patients were subdivided according to the presence of osteonecrosis into two groups:
group I: It included 30 SLE with symptomtic ON (confirmed with radiological investigation)
group II: It included 30 SLE patients without ON.
All of the included patients were subjected to detailed history taking with special emphasis on: age, disease duration, drug intake. Clinical examination including rheumatological examination was done to the patients, assessment of disease activity according to SLEDAI and assessment of organ damage using the (SLICC/ ACR) damage index. Laboratory investigations including CBC, ESR, ANA, anti-ds DNA, Anticardiolipin antibodies IgG and IgM, lupus anticoagulant antibodies, AST, ALT, serum triglyceride and cholesterol levels, C3, C4, serum creatinine, complete urinalysis and 24 hour urinary protein and lastly both MRI and DEXA scan to symptomatic cases.
In the present study the group of SLE patients with AVN was found to be younger with longer disease duration, higher BMI in AVN group than non-AVN group. Arthritis, livedo reticularis, renal, neuropsychiatric involvement, pulmonary involvement, photosensitivity, malar rash and cushingoid body were significantly more frequent in the AVN group.
We also found that the use of GCs, the average daily dose, duration of steroid intake, pulse steroid and cumulative steroid dose were associated with AVN and the use of antimalarial drugs was found to be protective against AVN.
Also the level of cholesterol and triglyceride was found to be higher in patients with AVN. The incidence of ON in SLE patients was affected by disease activity, the higher the SLEDAI score was significantly associated with accelerated incidence of ON. Our results showed that SLICC/ACR damage score was significantly higher in patients with AVN than those without.
The prevalence of antiphospholipid antibodies was not significantly different between SLE patients with and without AVN.
In conclusion, SLE activity (arthritis, renal, neuropsychiatric, pulmonary involvement), hyperlipidemia and steroids were the main predictors for osteonecrosis in SLE patient. In addition, the presence of antiphospholipid antibodies (aPL) isn’t a potential risk factor for AVN in our SLE patients. However, there is certainly a need for more well-designed and large-scale studies to better elucidate the predictors of AVN in SLE patients.