Aseptic necrosis and glucocorticosteroids in systemic lupus erythematosus: a reevaluation

To reassess predisposing factors in patients with systemic lupus erythematosus (SLE) who develop aseptic necrosis of bone, we studied 172 patients with SLE seen at our institution between 1975 and 1987 followed for longer than 1 year. Twenty-eight (16.3%) of these patients developed clinically apparent aseptic necrosis. In 12 of these 28 the continuous glucocorticosteroid dose was known. These 12 patients were compared to 15 controls with SLE followed for a minimum of 4.5 years for whom continuous glucocorticosteroid dosage was also known. We were unable to find any significant differences between patients with aseptic necrosis and controls in prevalence of specific lupus organ system involvement, Raynaud's phenomenon, or abnormal serological or hematological variables. Overall disease activity at the time of maximal glucocorticosteroid dosage did not differ significantly between the 2 groups but was slightly greater at the time SLE was diagnosed in the group with aseptic necrosis. Glucocorticosteroid intake during the first 1.5 years after diagnosis of SLE and during the third year after diagnosis was significantly greater for the patients with aseptic necrosis than for the control patients, as was glucocorticosteroid intake during the maximal 1, 3 and 6 months of therapy. We conclude that glucocorticosteroid intake is the major factor predisposing to aseptic necrosis in patients with SLE.