Epidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a Taiwanese population

Abstract Childhood-onset systemic lupus erythematosus (SLE) is associated with greater disease activity, more aggressive course, and high rates of organ damage. The prolonged use of corticosteroids in childhood SLE contributes to increased morbidity, including avascular necrosis (AVN). We conducted...

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Autores principales:	Hsin-Lin Tsai, Jei-Wen Chang, Jen-Her Lu, Chin-Su Liu
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2020
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5045cf4d758843e59dae3c81bb8bf88e
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spelling	oai:doaj.org-article:5045cf4d758843e59dae3c81bb8bf88e2021-12-02T18:48:00ZEpidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a Taiwanese population10.1038/s41598-020-71923-w2045-2322https://doaj.org/article/5045cf4d758843e59dae3c81bb8bf88e2020-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-71923-whttps://doaj.org/toc/2045-2322Abstract Childhood-onset systemic lupus erythematosus (SLE) is associated with greater disease activity, more aggressive course, and high rates of organ damage. The prolonged use of corticosteroids in childhood SLE contributes to increased morbidity, including avascular necrosis (AVN). We conducted this retrospective study using claims data from the Taiwan National Health Insurance Research Database, enrolling 1,472 children with newly-diagnosed SLE between 2005 and 2013. The mean age at the diagnosis of SLE was 15.5 ± 3.3 years, and the female to male ratio was 6.2:1. Thirty-nine patients (2.6%) developed symptomatic AVN during a mean follow-up of 4.6 ± 2.5 years. In multivariate analysis, the risk of AVN was higher in the patients with a daily prednisolone dose between 7.5 mg and 30 mg (HR 7.435, 95% CI 2.882–19.178, p < 0.001) and over 30 mg (HR 9.366, 95% CI 2.225–39.418, p = 0.002) than in those with a dose ≤ 7.5 mg/day. In addition, AVN was inversely correlated with the use of hydroxychloroquine > 627 days (HR 0.335, 95% CI 0.162–0.694, p = 0.003). In conclusion, high daily doses of prednisolone were associated with a significant risk of AVN, whereas the use of hydroxychloroquine > 627 days conferred an advantage. We suggest that the judicious use of corticosteroids combined with hydroxychloroquine might be a promising preventive strategy for AVN.Hsin-Lin TsaiJei-Wen ChangJen-Her LuChin-Su LiuNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 10, Iss 1, Pp 1-8 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Hsin-Lin Tsai Jei-Wen Chang Jen-Her Lu Chin-Su Liu Epidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a Taiwanese population
description	Abstract Childhood-onset systemic lupus erythematosus (SLE) is associated with greater disease activity, more aggressive course, and high rates of organ damage. The prolonged use of corticosteroids in childhood SLE contributes to increased morbidity, including avascular necrosis (AVN). We conducted this retrospective study using claims data from the Taiwan National Health Insurance Research Database, enrolling 1,472 children with newly-diagnosed SLE between 2005 and 2013. The mean age at the diagnosis of SLE was 15.5 ± 3.3 years, and the female to male ratio was 6.2:1. Thirty-nine patients (2.6%) developed symptomatic AVN during a mean follow-up of 4.6 ± 2.5 years. In multivariate analysis, the risk of AVN was higher in the patients with a daily prednisolone dose between 7.5 mg and 30 mg (HR 7.435, 95% CI 2.882–19.178, p < 0.001) and over 30 mg (HR 9.366, 95% CI 2.225–39.418, p = 0.002) than in those with a dose ≤ 7.5 mg/day. In addition, AVN was inversely correlated with the use of hydroxychloroquine > 627 days (HR 0.335, 95% CI 0.162–0.694, p = 0.003). In conclusion, high daily doses of prednisolone were associated with a significant risk of AVN, whereas the use of hydroxychloroquine > 627 days conferred an advantage. We suggest that the judicious use of corticosteroids combined with hydroxychloroquine might be a promising preventive strategy for AVN.
format	article
author	Hsin-Lin Tsai Jei-Wen Chang Jen-Her Lu Chin-Su Liu
author_facet	Hsin-Lin Tsai Jei-Wen Chang Jen-Her Lu Chin-Su Liu
author_sort	Hsin-Lin Tsai
title	Epidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a Taiwanese population
title_short	Epidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a Taiwanese population
title_full	Epidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a Taiwanese population
title_fullStr	Epidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a Taiwanese population
title_full_unstemmed	Epidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a Taiwanese population
title_sort	epidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a taiwanese population
publisher	Nature Portfolio
publishDate	2020
url	https://doaj.org/article/5045cf4d758843e59dae3c81bb8bf88e
work_keys_str_mv	AT hsinlintsai epidemiologyandriskfactorsforavascularnecrosisinchildhoodsystemiclupuserythematosusinataiwanesepopulation AT jeiwenchang epidemiologyandriskfactorsforavascularnecrosisinchildhoodsystemiclupuserythematosusinataiwanesepopulation AT jenherlu epidemiologyandriskfactorsforavascularnecrosisinchildhoodsystemiclupuserythematosusinataiwanesepopulation AT chinsuliu epidemiologyandriskfactorsforavascularnecrosisinchildhoodsystemiclupuserythematosusinataiwanesepopulation
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Epidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a Taiwanese population

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