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

J. Calvo-Alén, G. McGwin, S. Toloza, M. Fernández, J. M. Roseman, H. M. Bastian, E. J. Cepeda, Emilio Gonzalez, B. A. Baethge, B. J. Fessler, L. M. Vilá, J. D. Reveille, Gracielo S. Alarcón

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: Osteonecrosis is common in systemic lupus erythematosus (SLE) and often disabling. The role of glucocorticoids in its development is well known. Objective: To explore other possible risk factors for osteonecrosis in SLE. Methods: A nested matched case-control study undertaken in the context of a large, longitudinal, multiethnic lupus cohort (LUMINA), currently formed of 571 SLE patients meeting American College of Rheumatology criteria. All those developing symptomatic osteonecrosis after the diagnosis of SLE were considered cases. Two controls matched for age, disease duration, ethnicity, and centre were selected for each case. Cases and controls were compared by univariable analyses using selected variables. Variables with p<0.10 and those thought clinically relevant were entered into conditional logistic regression models including either the average dose or the highest dose of glucocorticoids, with osteonecrosis as the dependent variable. Results: 32 cases were identified and 59 matched controls selected (in five cases only one control could be found). By univariable analyses, both groups were largely comparable for socioeconomic-demographic, clinical, and laboratory variables. Cases were less exposed to hydroxychloroquine (as assessed by the percentage of exposure time) (p = 0.026), used higher doses of glucocorticoids (average and highest doses) (p = 0.011 and 0.001, respectively), and received cytotoxic drugs more often (p = 0.015). In the multivariable analyses only cytotoxic drug use (both models) and the highest dose of glucocorticoids remained associated with the occurrence of osteonecrosis. Conclusions: Cytotoxic drug use is a risk factor for the development of symptomatic osteonecrosis in SLE patients, along with glucocorticoids. No definite protective factors were identified.

Original languageEnglish (US)
Pages (from-to)785-790
Number of pages6
JournalAnnals of the Rheumatic Diseases
Volume65
Issue number6
DOIs
StatePublished - Jun 2006

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Osteonecrosis
Systemic Lupus Erythematosus
Glucocorticoids
Case-Control Studies
Pharmaceutical Preparations
Hydroxychloroquine
Therapeutics
Logistic Models
Logistics
Demography

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

Cite this

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. / Calvo-Alén, J.; McGwin, G.; Toloza, S.; Fernández, M.; Roseman, J. M.; Bastian, H. M.; Cepeda, E. J.; Gonzalez, Emilio; Baethge, B. A.; Fessler, B. J.; Vilá, L. M.; Reveille, J. D.; Alarcón, Gracielo S.

In: Annals of the Rheumatic Diseases, Vol. 65, No. 6, 06.2006, p. 785-790.

Research output: Contribution to journalArticle

Calvo-Alén, J. ; McGwin, G. ; Toloza, S. ; Fernández, M. ; Roseman, J. M. ; Bastian, H. M. ; Cepeda, E. J. ; Gonzalez, Emilio ; Baethge, B. A. ; Fessler, B. J. ; Vilá, L. M. ; Reveille, J. D. ; Alarcón, Gracielo S. / 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. In: Annals of the Rheumatic Diseases. 2006 ; Vol. 65, No. 6. pp. 785-790.
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abstract = "Background: Osteonecrosis is common in systemic lupus erythematosus (SLE) and often disabling. The role of glucocorticoids in its development is well known. Objective: To explore other possible risk factors for osteonecrosis in SLE. Methods: A nested matched case-control study undertaken in the context of a large, longitudinal, multiethnic lupus cohort (LUMINA), currently formed of 571 SLE patients meeting American College of Rheumatology criteria. All those developing symptomatic osteonecrosis after the diagnosis of SLE were considered cases. Two controls matched for age, disease duration, ethnicity, and centre were selected for each case. Cases and controls were compared by univariable analyses using selected variables. Variables with p<0.10 and those thought clinically relevant were entered into conditional logistic regression models including either the average dose or the highest dose of glucocorticoids, with osteonecrosis as the dependent variable. Results: 32 cases were identified and 59 matched controls selected (in five cases only one control could be found). By univariable analyses, both groups were largely comparable for socioeconomic-demographic, clinical, and laboratory variables. Cases were less exposed to hydroxychloroquine (as assessed by the percentage of exposure time) (p = 0.026), used higher doses of glucocorticoids (average and highest doses) (p = 0.011 and 0.001, respectively), and received cytotoxic drugs more often (p = 0.015). In the multivariable analyses only cytotoxic drug use (both models) and the highest dose of glucocorticoids remained associated with the occurrence of osteonecrosis. Conclusions: Cytotoxic drug use is a risk factor for the development of symptomatic osteonecrosis in SLE patients, along with glucocorticoids. No definite protective factors were identified.",
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T2 - 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

AU - Calvo-Alén, J.

AU - McGwin, G.

AU - Toloza, S.

AU - Fernández, M.

AU - Roseman, J. M.

AU - Bastian, H. M.

AU - Cepeda, E. J.

AU - Gonzalez, Emilio

AU - Baethge, B. A.

AU - Fessler, B. J.

AU - Vilá, L. M.

AU - Reveille, J. D.

AU - Alarcón, Gracielo S.

PY - 2006/6

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N2 - Background: Osteonecrosis is common in systemic lupus erythematosus (SLE) and often disabling. The role of glucocorticoids in its development is well known. Objective: To explore other possible risk factors for osteonecrosis in SLE. Methods: A nested matched case-control study undertaken in the context of a large, longitudinal, multiethnic lupus cohort (LUMINA), currently formed of 571 SLE patients meeting American College of Rheumatology criteria. All those developing symptomatic osteonecrosis after the diagnosis of SLE were considered cases. Two controls matched for age, disease duration, ethnicity, and centre were selected for each case. Cases and controls were compared by univariable analyses using selected variables. Variables with p<0.10 and those thought clinically relevant were entered into conditional logistic regression models including either the average dose or the highest dose of glucocorticoids, with osteonecrosis as the dependent variable. Results: 32 cases were identified and 59 matched controls selected (in five cases only one control could be found). By univariable analyses, both groups were largely comparable for socioeconomic-demographic, clinical, and laboratory variables. Cases were less exposed to hydroxychloroquine (as assessed by the percentage of exposure time) (p = 0.026), used higher doses of glucocorticoids (average and highest doses) (p = 0.011 and 0.001, respectively), and received cytotoxic drugs more often (p = 0.015). In the multivariable analyses only cytotoxic drug use (both models) and the highest dose of glucocorticoids remained associated with the occurrence of osteonecrosis. Conclusions: Cytotoxic drug use is a risk factor for the development of symptomatic osteonecrosis in SLE patients, along with glucocorticoids. No definite protective factors were identified.

AB - Background: Osteonecrosis is common in systemic lupus erythematosus (SLE) and often disabling. The role of glucocorticoids in its development is well known. Objective: To explore other possible risk factors for osteonecrosis in SLE. Methods: A nested matched case-control study undertaken in the context of a large, longitudinal, multiethnic lupus cohort (LUMINA), currently formed of 571 SLE patients meeting American College of Rheumatology criteria. All those developing symptomatic osteonecrosis after the diagnosis of SLE were considered cases. Two controls matched for age, disease duration, ethnicity, and centre were selected for each case. Cases and controls were compared by univariable analyses using selected variables. Variables with p<0.10 and those thought clinically relevant were entered into conditional logistic regression models including either the average dose or the highest dose of glucocorticoids, with osteonecrosis as the dependent variable. Results: 32 cases were identified and 59 matched controls selected (in five cases only one control could be found). By univariable analyses, both groups were largely comparable for socioeconomic-demographic, clinical, and laboratory variables. Cases were less exposed to hydroxychloroquine (as assessed by the percentage of exposure time) (p = 0.026), used higher doses of glucocorticoids (average and highest doses) (p = 0.011 and 0.001, respectively), and received cytotoxic drugs more often (p = 0.015). In the multivariable analyses only cytotoxic drug use (both models) and the highest dose of glucocorticoids remained associated with the occurrence of osteonecrosis. Conclusions: Cytotoxic drug use is a risk factor for the development of symptomatic osteonecrosis in SLE patients, along with glucocorticoids. No definite protective factors were identified.

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