Prevalence and risk factors of osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a multicentre cohort study
Objective We aimed to determine the prevalence and risk factors for osteonecrosis of the femoral head (ONFH) in a multicentre cohort of patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).Methods One hundred and eighty-six AAV patients who underwent radiographs and MRI scre...
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BMJ Publishing Group
2023-02-01
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| Online Access: | https://rmdopen.bmj.com/content/9/1/e002787.full |
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| author | Kei Ikeda Taro Iwamoto Shunsuke Furuta Junichi Nakamura Takeshi Umibe Masaki Hiraguri Hiroshi Nakajima Shin-ichiro Kagami Yoshihisa Kobayashi Hirotoshi Kawashima Ayako Matsuki Seiji Ohtori Masashi Fukuta Daiki Nakagomi Norihiro Mimura Takayuki Nakamura Aiko Saku Kentaro Takahashi Yoshie Sanayama Toyohiko Sugimoto Koichi Hirose Hiroaki Takatori Kenichi Suehiro Shigekazu Takahashi Tomohiro Tamachi Manami Kato Fumiyoshi Takizawa Yuya Kawarai Shigeo Hagiwara |
| author_facet | Kei Ikeda Taro Iwamoto Shunsuke Furuta Junichi Nakamura Takeshi Umibe Masaki Hiraguri Hiroshi Nakajima Shin-ichiro Kagami Yoshihisa Kobayashi Hirotoshi Kawashima Ayako Matsuki Seiji Ohtori Masashi Fukuta Daiki Nakagomi Norihiro Mimura Takayuki Nakamura Aiko Saku Kentaro Takahashi Yoshie Sanayama Toyohiko Sugimoto Koichi Hirose Hiroaki Takatori Kenichi Suehiro Shigekazu Takahashi Tomohiro Tamachi Manami Kato Fumiyoshi Takizawa Yuya Kawarai Shigeo Hagiwara |
| author_sort | Kei Ikeda |
| collection | DOAJ |
| description | Objective We aimed to determine the prevalence and risk factors for osteonecrosis of the femoral head (ONFH) in a multicentre cohort of patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).Methods One hundred and eighty-six AAV patients who underwent radiographs and MRI screening of bilateral hip joints at more than 6 months after initial remission induction therapy (RIT) were retrospectively assessed for the presence of ONFH.Results Among 186 AAV patients, 33 (18%) were diagnosed with ONFH. Among the patients with ONFH, 55% were asymptomatic and 64% had bilateral ONFH. Seventy-six per cent of ONFH joints were in precollapse stages (stage ≤2), whereas 24% of ONFH joints were in collapse stages (stage ≥3). Moreover, 56% of the precollapse stage joints were already at risk of future collapse (type ≥C-1). Even in asymptomatic ONFH patients, 39% of the precollapse stage joints were type ≥C-1. Prednisolone dose of ≥20 mg/day on day 90 of RIT was an independent risk factor for ONFH in AAV patients (OR 1.072, 95% CI 1.017 to 1.130, p=0.009). Rituximab use was a significant beneficial factor against ONFH (p=0.019), but the multivariate analysis rejected its significance (p=0.257).Conclusion Eighteen per cent of AAV patients developed ONFH, and two-thirds of the ONFH joints were already in collapse stages or at risk of future collapse. Prednisolone dose of ≥20 mg/day on day 90 of RIT was an independent risk factor for ONFH. A rapid reduction of glucocorticoids in RIT and early detection of precollapse ONFH by MRI may decrease and intervene ONFH development in AAV patients. |
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| spelling | doaj.art-0ad3c7cc22724128ab189f6ede6902ef2023-02-28T14:30:08ZengBMJ Publishing GroupRMD Open2056-59332023-02-019110.1136/rmdopen-2022-002787Prevalence and risk factors of osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a multicentre cohort studyKei Ikeda0Taro Iwamoto1Shunsuke Furuta2Junichi Nakamura3Takeshi Umibe4Masaki Hiraguri5Hiroshi Nakajima6Shin-ichiro Kagami7Yoshihisa Kobayashi8Hirotoshi Kawashima9Ayako Matsuki10Seiji Ohtori11Masashi Fukuta12Daiki Nakagomi13Norihiro Mimura14Takayuki Nakamura15Aiko Saku16Kentaro Takahashi17Yoshie Sanayama18Toyohiko Sugimoto19Koichi Hirose20Hiroaki Takatori21Kenichi Suehiro22Shigekazu Takahashi23Tomohiro Tamachi24Manami Kato25Fumiyoshi Takizawa26Yuya Kawarai27Shigeo Hagiwara28Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, JapanDepartment of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, JapanDepartment of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, JapanDepartment of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, JapanRheumatology Center, Matsudo City General Hospital, Matsudo, Chiba, JapanAllergy and Clinical Immunology Center, Japanese Red Cross Narita Hospital, Narita, Chiba, JapanDepartment of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, JapanResearch Center for Allergy and Clinical Immunology, Asahi General Hospital, Asahi, Chiba, JapanDepartment of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, Chiba, JapanDepartment of Allergy and Rheumatology, International University of Health and Welfare Narita Hospital, Narita, Chiba, JapanRheumatology Center, Matsudo City General Hospital, Matsudo, Chiba, JapanDepartment of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, JapanAllergy and Clinical Immunology Center, Japanese Red Cross Narita Hospital, Narita, Chiba, JapanDepartment of Rheumatology, University of Yamanashi Hospital, Chuo, Yamanashi, JapanDepartment of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, JapanResearch Center for Allergy and Clinical Immunology, Asahi General Hospital, Asahi, Chiba, JapanResearch Center for Allergy and Clinical Immunology, Asahi General Hospital, Asahi, Chiba, JapanRheumatology Center, Matsudo City General Hospital, Matsudo, Chiba, JapanDepartment of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba, JapanDepartment of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba, JapanDepartment of Allergy and Rheumatology, International University of Health and Welfare Narita Hospital, Narita, Chiba, JapanDepartment of Rheumatology, Hamamatsu Medical Center, Hamamatsu, Shizuoka, JapanCenter for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Narashino, Chiba, JapanCenter for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Narashino, Chiba, JapanDepartment of Allergy and Rheumatology, Chiba Rosai Hospital, Ichihara, Chiba, JapanDepartment of Internal Medicine, Seikei-kai Chiba Medical Center, Chiba, Chiba, JapanDepartment of Internal Medicine, Seikei-kai Chiba Medical Center, Chiba, Chiba, JapanDepartment of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, JapanDepartment of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, JapanObjective We aimed to determine the prevalence and risk factors for osteonecrosis of the femoral head (ONFH) in a multicentre cohort of patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).Methods One hundred and eighty-six AAV patients who underwent radiographs and MRI screening of bilateral hip joints at more than 6 months after initial remission induction therapy (RIT) were retrospectively assessed for the presence of ONFH.Results Among 186 AAV patients, 33 (18%) were diagnosed with ONFH. Among the patients with ONFH, 55% were asymptomatic and 64% had bilateral ONFH. Seventy-six per cent of ONFH joints were in precollapse stages (stage ≤2), whereas 24% of ONFH joints were in collapse stages (stage ≥3). Moreover, 56% of the precollapse stage joints were already at risk of future collapse (type ≥C-1). Even in asymptomatic ONFH patients, 39% of the precollapse stage joints were type ≥C-1. Prednisolone dose of ≥20 mg/day on day 90 of RIT was an independent risk factor for ONFH in AAV patients (OR 1.072, 95% CI 1.017 to 1.130, p=0.009). Rituximab use was a significant beneficial factor against ONFH (p=0.019), but the multivariate analysis rejected its significance (p=0.257).Conclusion Eighteen per cent of AAV patients developed ONFH, and two-thirds of the ONFH joints were already in collapse stages or at risk of future collapse. Prednisolone dose of ≥20 mg/day on day 90 of RIT was an independent risk factor for ONFH. A rapid reduction of glucocorticoids in RIT and early detection of precollapse ONFH by MRI may decrease and intervene ONFH development in AAV patients.https://rmdopen.bmj.com/content/9/1/e002787.full |
| spellingShingle | Kei Ikeda Taro Iwamoto Shunsuke Furuta Junichi Nakamura Takeshi Umibe Masaki Hiraguri Hiroshi Nakajima Shin-ichiro Kagami Yoshihisa Kobayashi Hirotoshi Kawashima Ayako Matsuki Seiji Ohtori Masashi Fukuta Daiki Nakagomi Norihiro Mimura Takayuki Nakamura Aiko Saku Kentaro Takahashi Yoshie Sanayama Toyohiko Sugimoto Koichi Hirose Hiroaki Takatori Kenichi Suehiro Shigekazu Takahashi Tomohiro Tamachi Manami Kato Fumiyoshi Takizawa Yuya Kawarai Shigeo Hagiwara Prevalence and risk factors of osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a multicentre cohort study RMD Open |
| title | Prevalence and risk factors of osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a multicentre cohort study |
| title_full | Prevalence and risk factors of osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a multicentre cohort study |
| title_fullStr | Prevalence and risk factors of osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a multicentre cohort study |
| title_full_unstemmed | Prevalence and risk factors of osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a multicentre cohort study |
| title_short | Prevalence and risk factors of osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a multicentre cohort study |
| title_sort | prevalence and risk factors of osteonecrosis of the femoral head in patients with anca associated vasculitis a multicentre cohort study |
| url | https://rmdopen.bmj.com/content/9/1/e002787.full |
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