AB0566 A COMPARATIVE ANALYSIS OF CLINICAL CHARACTERISTICS OF 86 CASES WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND ASEPTIC NECROSIS OF THE FEMORAL HEAD OR NON-FEMORAL HEAD AVASCULAR NECROSIS

Abstract

BackgroundSymptomatic osteonecrosis of the femoral head (ONFH) and avascular osteonecrosis (AVN) are two types of osteonecrosis which is a serious complication of systemic lupus erythematosus (SLE). Even their pathophysiology of them is similar, though the onset timing, symptoms and signs, and other clinical characteristics are different.ObjectivesTo compare the clinical characteristics of SLE combined with symptomatic ONFH and AVN.MethodsWe retrospectively analyzed the clinical data of 86 cases of SLE with symptomatic ONFH and AVN treated in the Department of Rheumatology and Immunology of The First Affiliated Hospital of Xi’an Jiaotong University from April 2013 to December 2021, and compared the similarities and differences between them.ResultsA total of 2730 patients with SLE were reviewed, including 60 patients combined with ONFH (male 9, female 51) and 26 patients combined with AVN (male 2, female 24). Morbility of ONFH was significantly higher than AVN. Compared with AVN group, the course of SLE was longer [(71.33±53.32) vs (48.69±35.11) months]，the time of glucocorticoids (GCs) use was longer [(67.47±51.71) vs (37.77±42.73) months], and the cumulative dosage of GCs was larger [(9.17±5.46) vs (6.02±6.66) g] in ONFH group. SLEDAI score was lower in ONFH group than in AVN group [(2.57±3.39) vs (4.46±4.81)]. The ONFH group had more Raynaud’s phenomenon and lower serum Vitamin-D3 level compared with AVN group. Anti-cardiolipin antibodies (ACA) positive (15.38%) and edema as the initial symptom (46.15%) were more common in AVN group. Bilateral lesions were more common in ONFH group (68.33% vs 42.31%). All of the above differences were significant (P＜0.05).ConclusionOur results indicate that the long time and large cumulative dosage exposure of GCs, stable SLE state, Raynaud’s phenomenon and low Vit-D3 value are more suggestive of ONFH than AVN. ACA positive and edema as an initial symptom are just the reverse.