Lupus & antiphospholipid syndrome
Risk factors for avascular necrosis in patients with systemic lupus erythematosus: a multi-center cohort study of Chinese systemic lupus erythematosus (SLE) Treatment and Research Group (CSTAR) Registry XXII
Authors' conclusion
Patients with SLE onset age ≤ 30, arthritis, existing organ damage (SDI ≥ 1) at registration, positive anti-RNP, and high glucocorticoid maximum daily dose at registration are at high risk for AVN and require attention.
Study context
- Population
- SLE patients in CSTAR without existing avascular necrosis (AVN) at registration, with at least two follow-ups and observation of no less than 2 years
- Participants
- 4,091 patients
- Outcome
- Risk factors predicting occurrence of AVN (osteonecrosis)
- Follow-up
- No less than 2 years
Methodological detailsregistry (CSTAR), univariate and multivariate Cox regression, risk stratification model, internal validation
- Registry (CSTAR)
- Univariate and multivariate Cox regression
- Risk stratification model
- Internal validation
Main finding
As reported in the abstract
Independent risk factors for AVN (multivariate Cox)
- Incident AVN
- 106 (2.59%)
- SLE onset age ≤ 30, HR
- 1.616 (p 0.023)
- Arthritis, HR
- 1.642 (p 0.018)
- Existing organ damage (SDI ≥ 1) at registration, HR
- 2.610 (p < 0.001)
- Positive anti-RNP, HR
- 1.709 (p 0.006)
- High GC maximum daily dose at registration, HR
- 1.747 (p 0.02)
Observational data: associations, not effects.
Further findings
Risk stratification model: high risk (3-6) vs low risk (0-2)
- AUC (moderate discrimination)
- 0.692
- Calibration curve drawn in internal validation
Original publication
Risk factors for avascular necrosis in patients with systemic lupus erythematosus: a multi-center cohort study of Chinese SLE Treatment and Research Group (CSTAR) Registry XXII. Arthritis Res Ther. Published 12 May 2023. doi:10.
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