Relative factors for osteonecrosis in the Chinese systemic lupus erythematosus patients: Meta-analysis

doi:10.3969/j.issn.2095-4344.2013.35.015

Abstract

Abstract:

BACKGROUND: Systemic lupus erythematosus is a kind of heterogeneous disease, and the difference of clinical features may also be the risk factors of osteonecrosis besides of treatment with glucocorticoids according to the literature. However, it remains controversial on the risk factors of osteonecrosis in systemic lupus erythematosus patients.
OBJECTIVE: To systematically review the major risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus.
METHODS: The CNKI database, CBMdisc database and Wanfang database were retrieved for the published case-control study literatures on the risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus. The literatures met the inclusion and exclusion criteria were included, and a Meta-analysis was conducted by RevMan 5.0 and Stata software. Then, the pooled odd ratio and 95% confidence interval of each risk factor were calculated.
RESULTS AND CONCLUSION: Ten case-control study literatures were included involving 332 cases in the case group and 986 cases in the control group. The pooled odd ratio and 95% confidence interval of each risk factor of osteonecrosis in the Chinese patients with systemic lupus erythematosus were as follows: Raynaud’s phenomenon 3.28(1.69-6.38), dental ulcer 2.95(2.13-4.09), renal involvement 1.21(0.83-1.74), vasculitis 5.64(2.84-11.21), hyperlipidemia 5.11(3.10-8.42), anti-phospholipid antibody 2.32(1.49-3.61) and joints involvement 2.02(1.33-3.07). It has been clear that the glucocorticoids is an independent risk factor of osteonecrosis in the patients with systemic lupus erythematosus. However, it is not the one and only risk factor. The following risk factors of vasculitis, hyperlipidemia, Raynaud’s phenomenon, dental ulcer, positive anti-phospholipid antibody and joints involvement are the risk factors of osteonecrosis in the patients with systemic lupus erythematosus.

Key words: bone and joint implants, evidence-based medicine of bone and joint, systemic lupus erythematosus, osteonecrosis, risk factor, glucocorticoids, vasc-ulitis, hyperlipidemia, Raynaud’s phenomenon, case-control study, Meta-analysis

CLC Number:

R318

Luo Zheng-liang, Shang Xi-fu, Li Xu, Hu Fei, He Rui. Relative factors for osteonecrosis in the Chinese systemic lupus erythematosus patients: Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(35): 6314-6320.

Figures/Tables 6

References

[1] Tsokos GC. Systemic lupus erythematosus. N Engl J Med. 2011;365(22): 2110-2121.http://www.ncbi.nlm.nih.gov/pubmed/22129255

[2] Pickering MC, Botto M, Taylor PR, et al. Systemic lupus erythematosus, complement deficiency, and apoptosis. Adv Immunol. 2001;76: 227-324.http://www.ncbi.nlm.nih.gov/pubmed/11079100

[3] Gordon C. Long‐term complications of systemic lupus erythematosus. Rheumatology (Oxford). 2002; 41(10): 1095-1100.http://www.ncbi.nlm.nih.gov/pubmed/12364626

[4] D'Cruz DP, 张卓莉. 系统性红斑狼疮[J]. 英国医学杂志: 中文版, 2006, 9(4): 236-241.http://www.cnki.net/KCMS/detail/detail.aspx?QueryID=12&CurRec=8&dbcode=CJFQ&dbname=CJFD0608&filename=YGYX200604022&urlid=&yx=

[5] Jones LC, Hungerford DS. The pathogenesis of osteonecrosis. Instr Course Lect. 2007;56:179-196.http://www.ncbi.nlm.nih.gov/pubmed/?term=Jones+L+C%2C+Hungerford+D+S.+The+pathogenesis+of+osteonecrosis%5BJ%5D.+Instructional+course+lectures%2C+2007%2C+56%3A+179.

[6] Zizic TM, Hungerford DS, Stevens MB. Ischemic bone necrosis in systemic lupus erythematosus. II. The early diagnosis of ischemic necrosis of bone. Medicine. 1980;59(2): 134-142.http://www.ncbi.nlm.nih.gov/pubmed/7360041

[7] Abu-Shakra M, Buskila D, Shoenfeld Y. Osteonecrosis in patients with SLE. Clin Rev Allergy Immunol. 2003;25(1): 13-24.http://www.ncbi.nlm.nih.gov/pubmed/?cmd=HistorySearch&querykey=7

[8] 齐云秋, 程敬亮, 潘芦翎, 等. 系统性红斑狼疮患者并发股骨头坏死危险因素研究[J]. 中华实验外科杂志, 2010, 27(12): 1937-1939.http://210.45.242.22/WFknowledgeServer_Mirror/D/Periodical_zhsywk201012060.aspx

[9] Johnson AE, Gordon C, Palmer RG, et al. The prevalence and incidence of systemic lupus erythematosus in Birmingham, England. Relationship to ethnicity and country of birth. Arthritis Rheum. 1995;38(4): 551-558.http://www.ncbi.nlm.nih.gov/pubmed/7718010

[10] Hedges LV, Pigott TD. The power of statistical tests in meta-analysis. Psychol Methods. 2001;6(3):203-217.http://www.ncbi.nlm.nih.gov/pubmed?term=(%22Psychological%20methods%22%5BJournal%5D)%20AND%20Fixed-and%20random-effects%20models%20in%20meta-analysis

[11] Egger M, Smith GD, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109): 629-634.http://www.ncbi.nlm.nih.gov/pubmed/?term=Egger+M%2C+Smith+G+D%2C+Schneider+M%2C+et+al.+Bias+in+meta-analysis+detected+by+a+simple%2C+graphical+test%5BJ%5D.+Bmj%2C+1997%2C+315(7109)%3A+629-634.

[12] 李姝玉, 胡大伟. 系统性红斑狼疮并发无菌性股骨头坏死的相关因素分析[J]. 中国骨质疏松杂志, 2008, 14(5): 324-327.http://www.cnki.net/KCMS/detail/detail.aspx?QueryID=3&CurRec=1&dbcode=CJFQ&dbname=CJFD0608&filename=ZGZS200805007&urlid=&yx=&uid=WEEvREcwSlJHSldRa1FhdkF0Rk4yakozWGhobUVseDZVRTNVOXZhQ3NFTGFsWU1YK0NlbU1RTzM1eUxpdSs0PQ==

[13] 刘兆云, 赵铖, 米存东, 等. 系统性红斑狼疮并发股骨头缺血性坏死相关因素分析[J]. 实用医学杂志, 2011, 27(7): 1226-1228.http://www.cnki.net/KCMS/detail/detail.aspx?QueryID=9&CurRec=1&dbcode=CJFQ&dbname=CJFD1112&filename=SYYZ201107041&urlid=&yx=&uid=WEEvREcwSlJHSldRa1FhdkF0Rk4yakozWGhobUVseDZVRTNVOXZhQ3NFTGFsWU1YK0NlbU1RTzM1eUxpdSs0PQ==

[14]沈凌汛, 夏菲, 余立凯, 等. 系统性红斑狼疮患者并发无菌性骨坏死的调查分析[J]. 中华风湿病学杂志, 2005, 9(1):20-23.http://www.cnki.net/KCMS/detail/detail.aspx?QueryID=3&CurRec=1&dbcode=CJFQ&dbname=CJFD0305&filename=FSBZ200501007&urlid=&yx=&uid=WEEvREcwSlJHSldRa1FhcEFjU3VlY3FPeExNZlpyYVNGRWFZM0FKd2kwbEJhc2RRNGhwV2ttOTFMRTMvLzk4PQ==

[15] 唐福林, 金聂, 吴敏, 等. 系统性红斑狼疮并发无菌性骨坏死的危险因素分析[J]. 中华风湿病学杂志, 1999, 3(3):166-168.http://www.cnki.net/KCMS/detail/detail.aspx?QueryID=3&CurRec=1&dbcode=CJFQ&dbname=CJFD9902&filename=FSBZ199903010&urlid=&yx=&uid=WEEvREcwSlJHSldRa1FiNDFMOWU4V3Q2RjNUU094bCtGYkRGK24rTmRDckZ1TnRmOUc4MEdXbHhRNHExa2trPQ==

[16]王冬雪, 李桂叶, 马丽, 等. 系统性红斑狼疮并发无菌性股骨头坏死的临床研究[J]. 中华内科杂志, 2009, 48(11):926-929.http://210.45.242.22/WFknowledgeServer_Mirror/D/Periodical_zhnk200911009.aspx

[17]玄敬敬, 张源潮, 杨清锐. 系统性红斑狼疮合并无菌性股骨头坏死的危险因素分析[J]. 山东大学学报: 医学版, 2011, 49(3):109-114.http://www.cnki.net/KCMS/detail/detail.aspx?QueryID=23&CurRec=1&dbcode=CJFQ&dbname=CJFD1112&filename=SDYB201103027&urlid=&yx=&uid=WEEvREcwSlJHSldRa1FiNDFMOWU4V3Q2RjNUU094bCtGYkRGK24rTmRDckZ1TnRmOUc4MEdXbHhRNHExa2trPQ==

[18]张佩莲, 冒长峙, 李学平, 等. 系统性红斑狼疮合并股骨头坏死11例[J]. 中华皮肤科杂志, 2004, 37(6):366.http://www.cnki.net/KCMS/detail/detail.aspx?QueryID=28&CurRec=1&dbcode=CJFQ&dbname=CJFD0305&filename=ZHPF200406026&urlid=&yx=&uid=WEEvREcwSlJHSldRa1FiNDFMOWU4V3Q2RjNUU094bCtGYkRGK24rTmRDckZ1TnRmOUc4MEdXbHhRNHExa2trPQ==

[19]张秋霞, 陈镇秋. 系统性红斑狼疮并发股骨头缺血性坏死的相关性临床研究[J]. 新中医, 2008, 40(8):27-28.http://www.cnki.net/KCMS/detail/detail.aspx?QueryID=34&CurRec=1&dbcode=CJFQ&dbname=CJFD0608&filename=REND200808018&urlid=&yx=&uid=WEEvREcwSlJHSldRa1FiNDFMOWU4V3Q2RjNUU094bCtGYkRGK24rTmRDckZ1TnRmOUc4MEdXbHhRNHExa2trPQ==

[20]郑朝晖, 赵占正, 刘章锁. 系统性红斑狼疮并发股骨头坏死相关因素分析[J]. 中国误诊学杂志, 2006, 6(17):3311-3312.http://www.cnki.net/KCMS/detail/detail.aspx?QueryID=38&CurRec=1&dbcode=CJFQ&dbname=CJFD0608&filename=ZWZX200617024&urlid=&yx=&uid=WEEvREcwSlJHSldRa1FiNDFMOWU4V3Q2RjNUU094bCtGYkRGK24rTmRDckZ1TnRmOUc4MEdXbHhRNHExa2trPQ==

[21] Asherson RA, Liote F, Page B, et al. Avascular necrosis of bone and antiphospholipid antibodies in systemic lupus erythematosus. J Rheumatol. 1993;20(2): 284-288.http://www.ncbi.nlm.nih.gov/pubmed/8474066

[22] Gladman DD, Chaudhry-Ahluwalia V, Ibañez D, et al. Outcomes of symptomatic osteonecrosis in 95 patients with systemic lupus erythematosus. J Rheumatol. 2001;28(10): 2226-2229.http://www.ncbi.nlm.nih.gov/pubmed/?term=(Gladman+DD%5BAuthor%5D)+AND+Outcomes+of+symptomatic+osteonecrosis+in+95+patients+with+systemic+lupus+erythematosus

[23] Sayarlioglu M, Yuzbasioglu N, Inanc M, et al. Risk factors for avascular bone necrosis in patients with systemic lupus erythematosus. Rheumatol Int. 2012;32(1): 177-182.http://www.ncbi.nlm.nih.gov/pubmed/?term=(Sayarlioglu+M%5BAuthor%5D)+AND+Risk+factors+for+avascular+bone+necrosis+in+patients+with+systemic+lupus+erythematosus

[24] Weinstein RS. Glucocorticoid-induced osteonecrosis. Endocrine. 2012;41(2): 183-190.http://www.ncbi.nlm.nih.gov/pubmed/22169965

[25] Assouline-Dayan Y, Chang C, Greenspan A, et al. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum. 2002;32(2): 94-124.http://www.ncbi.nlm.nih.gov/pubmed?term=(Assouline-Dayan%20Y%5BAuthor%5D)%20AND%20(Pathogenesis%20and%20natural%20history%20of%20osteonecrosis)

[26] Jones JP Jr. Intravascular coagulation and osteonecrosis. Clin Orthop Relat Res. 1992;277: 41-53.http://www.ncbi.nlm.nih.gov/pubmed/1532547

[27] Oinuma K, Harada Y, Nawata Y, et al. Osteonecrosis in patients with systemic lupus erythematosus develops very early after starting high dose corticosteroid treatment. Ann Rheum Dis. 2001;60(12): 1145-1148.http://www.ncbi.nlm.nih.gov/pubmed/11709458

[28] Colwell CW Jr, Robinson CA, Stevenson DD, et al. Osteonecrosis of the femoral head in patients with inflammatory arthritis or asthma receiving corticosteroid therapy. Orthopedics. 1996;19(11): 941-946.http://www.ncbi.nlm.nih.gov/pubmed/8936529

[29] Mok CC, Lau CS, Wong RW. Risk factors for avascular bone necrosis in systemic lupus erythematosus. Br J Rheumatol.1998;37(8): 895-900.http://www.ncbi.nlm.nih.gov/pubmed/9734682

[30] Leventhal GH, Dorfman HD. Aseptic necrosis of bone in systemic lupus erythematosus. Semin Arthritis Rheum. 1974;4(1): 73-93.http://www.ncbi.nlm.nih.gov/pubmed/4846262

[31] Fialho SCMS, Bonfa E, Vitule LF, et al. Disease activity as a major risk factor for osteonecrosis in early systemic lupus erythematosus. Lupus. 2007;16(4): 239-244.http://www.ncbi.nlm.nih.gov/pubmed/?term=(Fialho+SCMS%5BAuthor%5D)+AND+(Disease+activity+as+a+major+risk+factor+for+osteonecrosis+in+early+systemic+lupus+erythematosus)

[32] Sari RA, Polat MF, Taysi S, et al. Serum lipoprotein (a) level and its clinical significance in patients with systemic lupus erythematosus. Clin Rheumatol. 2002;21(6): 520-524.http://www.ncbi.nlm.nih.gov/pubmed/?term=(Sar%C4%B1+RA%5BAuthor%5D)+AND+(Serum+lipoprotein+(a)+level+and+its+clinical+significance+in+patients+with+systemic+lupus+erythematosus)

[33] Houssiau FA, Toukap ANZ, Depresseux G, et al. Magnetic resonance imaging-detected avascular osteonecrosis in systemic lupus erythematosus: lack of correlation with antiphospholipid antibodies. Br J Rheumatol. 1998;37(4): 448-453.http://www.ncbi.nlm.nih.gov/pubmed/?term=Magnetic+resonance+imaging-detected+avascular+osteonecrosis+in+systemic+lupus+erythematosus%3A+lack+of+correlation+with+antiphospholipid+antibodies

[34] Mok MY, Farewell VT, Isenberg DA. Risk factors for avascular necrosis of bone in patients with systemic lupus erythematosus: Is there a role for antiphospholipid antibodies? Ann Rheum Dis. 2000;59(6): 462-467.http://www.ncbi.nlm.nih.gov/pubmed/?term=Risk+factors+for+avascular+necrosis+of+bone+in+patients+with+systemic+lupus+erythematosus%3A+Is+there+a+role+for+antiphospholipid+antibodies

[35] Tektonidou MG, Malagari K, Vlachoyiannopoulos PG, et al. Asymptomatic avascular necrosis in patients with primary antiphospholipid syndrome in the absence of corticosteroid use: a prospective study by magnetic resonance imaging. Arthritis Rheum. 2003;48(3): 732-736.http://www.ncbi.nlm.nih.gov/pubmed/?term=Asymptomatic+avascular+necrosis+in+patients+with+primary+antiphospholipid+syndrome+in+the+absence+of+corticosteroid+use%3A+a+prospective+study+by+magnetic+resonance+imaging

[36] Nagasawa K, Ishii Y, Mayumi T, et al. Avascular necrosis of bone in systemic lupus erythematosus: possible role of haemostatic abnormalities. Ann Rheum Dis. 1989;48(8): 672-676.http://www.ncbi.nlm.nih.gov/pubmed/2506841

[37] Nagasawa K, Tada Y, Koarada S, et al. Prevention of steroid-induced osteonecrosis of femoral head in systemic lupus erythematosus by anti-coagulant. Lupus. 2006;15(6): 354-357.http://www.ncbi.nlm.nih.gov/pubmed/16830881

[38] Smith FE, Sweet DE, Brunner CM, et al. Avascular necrosis in SLE. An apparent predilection for young patients. Ann Rheum Dis. 1976;35(3): 227-232.http://www.ncbi.nlm.nih.gov/pubmed/?term=Avascular+necrosis+in+SLE.+An+apparent+predilection+for+young+patients

[39] Gladman DD, Urowitz MB, Chaudhry-Ahluwalia V, et al. Predictive factors for symptomatic osteonecrosis in patients with systemic lupus erythematosus. J Rheumatol. 2001;28(4): 761-765.http://www.ncbi.nlm.nih.gov/pubmed/11327247

[40] Calvo-Alén J, McGwin G, Toloza S, et al. Systemic lupus erythematosus in a multiethnic US cohort (LUMINA): XXIV. Cytotoxic treatment is an additional risk factor for the development of symptomatic osteonecrosis in lupus patients: results of a nested matched case–control study. Ann Rheum Dis. 2006;65(6): 785-790.http://www.ncbi.nlm.nih.gov/pubmed/?term=Systemic+lupus+erythematosus+in+a+multiethnic+US+cohort+(LUMINA)%3A+XXIV.+Cytotoxic+treatment+is+an+additional+risk+factor+for+the+development+of+symptomatic+osteonecrosis+in+lupus+patients%3A+results+of+a+nested+matched+case%E2%80%93control+study

[41] DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3): 177-188.http://www.ncbi.nlm.nih.gov/pubmed