The Risk Factors of Avascular Necrosis in Patients with Systemic Lupus Erythematosus: a Meta-analysis

The aim of this study was to determine the risk factors for avascular necrosis (AVN) in patients with systemic lupus erythematosus (SLE). Four electronic databases (PubMed, EMBASE, Ovid, and Science Direct) were searched for. The search was performed to identify the articles as to SLE with AVN before September 2013. The clinical and laboratory data were extracted, and a meta-analysis was performed to identify the risk factors for AVN in patients with SLE. Publication bias was assessed with funnel plot and Egger's test. A total of 995 papers were found from the four databases; 16 studies were finally included. Pooled analysis showed the following result. The result showed that arthritis (odds ratio (OR) = 2.448, 95 % confidence interval (CI) = 1.617-3.707), cushingoid (OR = 3.890, 95 % CI = 1.591-9.510), gastrointestinal involvement (OR = 2.054, 95 % CI = 1.283-3.290), hypertension (OR = 1.482, 95 % CI = 1.093-2.008), oral ulcers (OR = 1.877, 95 % CI = 1.182-2.979), pleuritis (OR = 2.302, 95 % CI = 1.325-4.001), renal disease (OR = 1.475, 95 % CI = 1.124-1.936), and vasculitis (OR = 2.591, 95 % CI = 1.358-4.944) were relevant with AVN in SLE patients. Cytotoxic drug (OR = 1.834, 95 % CI = 1.065-3.156, P = 0.029), the total cumulative dose (Standard Mean Difference (SMD) = 1.104, 95 % CI = 0.118-2.090, P = 0.028), maximum daily dose (SMD = 0.484, 95 % CI = 0.288-0.678, P < 0.001), and mean daily dose (SMD = 1.305, 95 % CI = 0.061-2.549, P = 0.040) were significantly higher in AVN group. There were no significantly laboratory features that appeared in this pooled analysis. We conclude that arthritic, cushingoid, gastrointestinal involvement, hypertension, oral ulcers, pleuritis, renal disease, vasculitis, cytotoxic drug, and steroid treatment may contribute to AVN in SLE patients.