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Epidemiology and risk factors associated with avascular necrosis in patients with autoimmune diseases: a nationwide

Hsin-Lin Tsai1,2, Jei-Wen Chang2,3, Jen-Her Lu2,3

  • 1Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.

The Korean Journal of Internal Medicine
|March 2, 2022
PubMed

Insights

Avascular necrosis (AVN) affects 1.0% of autoimmune patients, with higher risks in systemic lupus erythematosus. Male sex, alcoholism, and corticosteroid use are key risk factors for AVN, while hydroxychloroquine offers protection.

Area of Science:

  • Rheumatology
  • Orthopedics
  • Epidemiology

Background:

  • Avascular necrosis (AVN) is bone death due to interrupted blood supply.
  • Patients with autoimmune diseases are at risk for AVN.
  • Understanding AVN epidemiology and risk factors in this population is crucial.

Purpose of the Study:

  • To investigate the epidemiology of AVN in patients with autoimmune diseases.
  • To identify risk factors associated with AVN development in this cohort.

Main Methods:

  • Population-based retrospective cohort analysis using Taiwan National Health Insurance Research Database.
  • Included 49,636 patients with autoimmune diseases (2005-2013).
  • Cox regression analysis identified risk factors for AVN.

Main Results:

  • 1.0% (490/49,636) of patients developed symptomatic AVN.
  • Systemic lupus erythematosus patients had a higher AVN risk.
  • AVN correlated positively with male sex, alcoholism, and corticosteroid dosage; inversely with hydroxychloroquine use.

Conclusions:

  • Male sex, SLE, alcoholism, and corticosteroid use are independent AVN risk factors in autoimmune patients.
  • Hydroxychloroquine use over 0.6 years significantly protects against AVN.
  • Clinicians should monitor at-risk patients for early AVN diagnosis.
Abstract

Keywords:
Autoimmune diseaseOsteonecrosisPrednisoloneSystemic lupus erythematosus

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