Evaluation of avascular necrosis in patients with systemic lupus erythematosus

Objectives: Our study aimed to evaluate the clinical features and identify risk factors that may cause avascular necrosis. Materials and Methods: Of the 406 patients aged 18 years and over who met the 2012 SLICC criteria and applied to the ÇÜTF Hospital Rheumatology outpatient clinic between January 2012 and October 2022, 247 patients who did not have overlap syndrome and had sufficient data were included in the study. The data of the patients were obtained from the computer automation system and outpatient clinic files used in our hospital. The date of diagnosis of avascular necrosis was taken as the date of the first radiological imaging in which pathology was detected. Clinical, laboratory and demographic data of the patients were recorded. Results: In our study, 39 out of 406 patients developed avascular necrosis and the frequency of avascular necrosis was found to be % 9,6. Gender, age, age at diagnosis, alcohol, smoking, comorbidities, history of thromboembolic events, pleura, pericardium, joint and lung involvement, platelet count, antiphospholipid antibody syndrome, proteinuria, complements, history of intravenosus pulse steroid treatment, use of antihyperlipidemic and anticoagulant drugs, lipid profile, creatinine and glomerulofiltration rate was found between no significant relationship and avascular necrosis. Duration of disease and steroid use, osteoporosis, Raynaud's phenomenon and vasculitic involvement, immunosuppressive drug use (especially cyclophosphamide and rituximab), neuropsychiatric and renal involvement, autoimmune hemolytic anemia, leukopenia, total cumulative steroid dose, maximum daily and average daily steroid doses, sedimentation. and CRP and hemoglobin values were found to be significantly higher in those who developed avascular necrosis. Antiplatelet use was significantly higher in the group that did not develop avascular necrosis. Among the autoantibodies, only lupus anticoagulant levels were significantly higher in patients with avascular necrosis. Conclusion: It was observed that lupus related vasculitis and system involvement, lupus anticoagulant and Raynaud phenomenon and steroid treatment increased the risk of developing avascular necrosis. In our study, it was observed that high daily steroid doses and total steroid doses increased the risk in the first years of treatment and that antiplatelets had a protective effect. We think that it is necessary to conduct a prospective study with large patient series to elucidate the etiological causes more clearly. Key Words: Avascular Necrosis, Systemic Lupus Erythematosus