Avascular necrosis in patients with systemic lupus erythematosus: Prevalence, associations, risk factors and outcome.

This article focuses on the prevalence and risk factors of symptomatic avascular necrosis (AVN) in patients with systemic lupus erythematosus (SLE). In a cohort of 912 SLE patients, symptomatic AVN was found in 11.6%, predominantly affecting the hip and often involving multiple joints. Key risk factors for AVN included younger age at SLE diagnosis, higher daily and cumulative steroid doses, presence of antiphospholipid antibodies, and clinical features such as oral ulcers, arthritis, nephritis, and neurologic involvement. Early-onset AVN (within one year of SLE diagnosis) was associated with higher disease activity measured by the SLE Disease Activity Index 2000 (SLEDAI-2K) and greater steroid exposure. The study suggests that minimizing steroid dose and controlling disease activity early in SLE may help prevent the development of debilitating AVN.