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High-Dose Intravenous Methylprednisolone Therapy Associated with Osteonecrosis in Patients with Systemic Lupus Erythematosus

Servicio de Medicina, Hospital Dr Sótero del Rio, Servicio de Salud Metropolitano Sur-Oriente, Santiago

Sergio Jacobelli

Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

Mauricio Leissner

Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

Myriam González

Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

Luis Villarroel

Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

Santiago Rivero

Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

Osteonecrosis is related to the use of steroids in patients with systemic lupus erythematosus (SLE); its association with the use of 'pulses' of methylprednisolone (PMP) is not clear at present. In a retrospective analysis of 190 patients with SLE we found that 19% of 36 patients treated with PMP had osteonecrosis compared with 6% of 154 patients without that treatment (P < 0.04). Risk factors associated with osteonecrosis were PMP treatment, cushingoid appearance, steroid doses 40 mg/day during the first month of treatment, a ratio of steroid dose in grams/year 12, hematuria and proteinuria. In a stepwise regression model, when cushingoid appearance was excluded, PMP became the only significant factor (P = 0.045).

We conclude that osteonecrosis can be considered a long-term complication of PMP treatment in SLE patients.

Key Words: Osteonecrosis • Methylprednisolone • Systemic lupus erythematosus

Lupus, Vol. 1, No. 6, 401-405 (1992)
DOI: 10.1177/096120339200100610


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