PMID- 36849207 OWN - NLM STAT- MEDLINE DCOM- 20230301 LR - 20230310 IS - 2056-5933 (Electronic) IS - 2056-5933 (Linking) VI - 9 IP - 1 DP - 2023 Feb TI - Prevalence and risk factors of osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a multicentre cohort study. LID - 10.1136/rmdopen-2022-002787 [doi] LID - e002787 AB - 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 /=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. CI - (c) Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Mimura, Norihiro AU - Mimura N AUID- ORCID: 0000-0002-7787-713X AD - Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan. FAU - Iwamoto, Taro AU - Iwamoto T AUID- ORCID: 0000-0003-1663-3518 AD - Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan taro.iwamoto@chiba-u.jp. FAU - Furuta, Shunsuke AU - Furuta S AUID- ORCID: 0000-0003-2482-2685 AD - Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan. FAU - Ikeda, Kei AU - Ikeda K AUID- ORCID: 0000-0003-0574-9611 AD - Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan. FAU - Kobayashi, Yoshihisa AU - Kobayashi Y AUID- ORCID: 0000-0002-3645-937X AD - Department of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, Chiba, Japan. FAU - Nakamura, Takayuki AU - Nakamura T AUID- ORCID: 0000-0001-9096-2796 AD - Research Center for Allergy and Clinical Immunology, Asahi General Hospital, Asahi, Chiba, Japan. FAU - Saku, Aiko AU - Saku A AUID- ORCID: 0000-0002-9632-5744 AD - Research Center for Allergy and Clinical Immunology, Asahi General Hospital, Asahi, Chiba, Japan. FAU - Kagami, Shin-Ichiro AU - Kagami SI AUID- ORCID: 0000-0001-9439-8918 AD - Research Center for Allergy and Clinical Immunology, Asahi General Hospital, Asahi, Chiba, Japan. FAU - Matsuki, Ayako AU - Matsuki A AUID- ORCID: 0000-0002-5041-2551 AD - Rheumatology Center, Matsudo City General Hospital, Matsudo, Chiba, Japan. FAU - Takahashi, Kentaro AU - Takahashi K AUID- ORCID: 0000-0003-2157-3783 AD - Rheumatology Center, Matsudo City General Hospital, Matsudo, Chiba, Japan. FAU - Umibe, Takeshi AU - Umibe T AUID- ORCID: 0000-0002-6053-4528 AD - Rheumatology Center, Matsudo City General Hospital, Matsudo, Chiba, Japan. FAU - Nakagomi, Daiki AU - Nakagomi D AUID- ORCID: 0000-0003-1682-9799 AD - Department of Rheumatology, University of Yamanashi Hospital, Chuo, Yamanashi, Japan. FAU - Sanayama, Yoshie AU - Sanayama Y AUID- ORCID: 0000-0003-4961-265X AD - Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba, Japan. FAU - Sugimoto, Toyohiko AU - Sugimoto T AUID- ORCID: 0000-0002-0379-3400 AD - Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba, Japan. FAU - Fukuta, Masashi AU - Fukuta M AUID- ORCID: 0000-0001-5774-0251 AD - Allergy and Clinical Immunology Center, Japanese Red Cross Narita Hospital, Narita, Chiba, Japan. FAU - Hiraguri, Masaki AU - Hiraguri M AUID- ORCID: 0000-0002-4682-6268 AD - Allergy and Clinical Immunology Center, Japanese Red Cross Narita Hospital, Narita, Chiba, Japan. FAU - Kawashima, Hirotoshi AU - Kawashima H AUID- ORCID: 0000-0001-7364-127X AD - Department of Allergy and Rheumatology, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan. FAU - Hirose, Koichi AU - Hirose K AUID- ORCID: 0000-0001-7498-9630 AD - Department of Allergy and Rheumatology, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan. FAU - Takatori, Hiroaki AU - Takatori H AUID- ORCID: 0000-0003-0539-5040 AD - Department of Rheumatology, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan. FAU - Suehiro, Kenichi AU - Suehiro K AUID- ORCID: 0000-0003-2605-3875 AD - Center for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Narashino, Chiba, Japan. FAU - Takahashi, Shigekazu AU - Takahashi S AUID- ORCID: 0000-0002-7204-2627 AD - Center for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Narashino, Chiba, Japan. FAU - Tamachi, Tomohiro AU - Tamachi T AUID- ORCID: 0000-0001-8295-1472 AD - Department of Allergy and Rheumatology, Chiba Rosai Hospital, Ichihara, Chiba, Japan. FAU - Kato, Manami AU - Kato M AUID- ORCID: 0000-0002-0144-9606 AD - Department of Internal Medicine, Seikei-kai Chiba Medical Center, Chiba, Chiba, Japan. FAU - Takizawa, Fumiyoshi AU - Takizawa F AUID- ORCID: 0000-0002-2074-458X AD - Department of Internal Medicine, Seikei-kai Chiba Medical Center, Chiba, Chiba, Japan. FAU - Kawarai, Yuya AU - Kawarai Y AUID- ORCID: 0000-0002-3321-9389 AD - Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan. FAU - Hagiwara, Shigeo AU - Hagiwara S AUID- ORCID: 0000-0002-2734-8408 AD - Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan. FAU - Nakamura, Junichi AU - Nakamura J AUID- ORCID: 0000-0003-4005-8832 AD - Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan. FAU - Ohtori, Seiji AU - Ohtori S AUID- ORCID: 0000-0001-5738-6184 AD - Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan. FAU - Nakajima, Hiroshi AU - Nakajima H AUID- ORCID: 0000-0001-8595-9381 AD - Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan. LA - eng PT - Journal Article PT - Multicenter Study PL - England TA - RMD Open JT - RMD open JID - 101662038 RN - 9PHQ9Y1OLM (Prednisolone) SB - IM MH - Humans MH - Femur Head MH - Prevalence MH - Retrospective Studies MH - *Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications/drug therapy/epidemiology MH - Prednisolone MH - *Osteonecrosis MH - Risk Factors PMC - PMC9972441 OTO - NOTNLM OT - Magnetic Resonance Imaging OT - epidemiology OT - glucocorticoids OT - systemic vasculitis COIS- Competing interests: KI has received research grants from Mitsubishi-Tanabe Pharma and has received honoraria for lectures from Abbvie, Mitsubishi-Tanabe Pharma, Eli Lilly Japan, Novartis, Pfizer Japan, Janssen Pharmaceutical, Eisai, Gilead Sciences and Bristol Myers Squibb, all unrelated to the current manuscript. HN has received research grants from Chugai Pharmaceutical, Abbvie, Takeda Pharmaceutical, Astellas Pharma, Eli Lilly Japan, Asahikasei Pharma, Pfizer Japan, UCB Japan, Eizai, Mitsubishi Tanabe Pharma and Bristol Myers Squibb, and has received honoraria for lectures from Chugai Pharmaceutical, Abbvie, Takeda Pharmaceutical, Astellas Pharma, Eli Lilly Japan, Asahikasei Pharma, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Eisai, Bristol Myers Squibb and Nippon Kayaku, all unrelated to the current manuscript. EDAT- 2023/02/28 06:00 MHDA- 2023/03/03 06:00 PMCR- 2023/02/27 CRDT- 2023/02/27 20:53 PHST- 2022/10/11 00:00 [received] PHST- 2023/01/20 00:00 [accepted] PHST- 2023/02/27 20:53 [entrez] PHST- 2023/02/28 06:00 [pubmed] PHST- 2023/03/03 06:00 [medline] PHST- 2023/02/27 00:00 [pmc-release] AID - rmdopen-2022-002787 [pii] AID - 10.1136/rmdopen-2022-002787 [doi] PST - ppublish SO - RMD Open. 2023 Feb;9(1):e002787. doi: 10.1136/rmdopen-2022-002787.