Risk factors for osteonecrosis severity among Egyptian systemic lupus erythematosus patients: Magnetic resonance imaging (MRI) staging

Abstract Aim of the work To determine the risk factors of bilateral and severe (advanced) osteonecrosis femoral head (ONFH) as assessed by magnetic resonance imaging (MRI) staging in Egyptian SLE patients. Patients and methods Sixty SLE patients were studied and subdivided into two groups according to the presence or absence of symptomatic osteonecrosis. Full medical history, musculoskeletal examination, laboratory and serologic tests were done to all patients. SLE disease activity index (SLEDAI), systemic lupus international collaboration clinics damage index (SLICC/DI), health assessment questionairre (HAQ) disability index and the visual analogue scale (VAS-pain) were assessed. 30 patients with symptomatic ONFH were identified and staged by MRI according to Ficat and Arlet  classification. Dual energy x-ray absorptiometry (DEXA) scan was performed. Results The mean age at-onset of patients with ONFH was significantly lower than those without (20.7 ± 5.9 vs 30.4 ± 7.9 years; p  Conclusion Nephritis, serositis, GI involvement, arthritis, steroids are key predictors for advanced ONFH while HCQ was protective. Risk factors for bilateral ONFH were serositis, nephritis, increased damage-index and VAS-pain.