Background Fever and musculoskeletal pain are manifestations of systemic lupus erythematosus (SLE). These symptoms might be confused with the presentations of osteomyelitis, especially in SLE patients. On the other hand, SLE patients may have higher risk to get infection, including osteomyelitis, due to immunodeficiency.
Objectives This study aimed to investigate the epidemiology and risk factors of osteomyelitis in SLE patients.
Methods We conducted this population-based cohort in entire Taiwanese by using Taiwan National Health Insurance Research Database. Patients with SLE and age- and sex-matched control group without SLE were enrolled. The primary endpoint was the first occurrence of osteomyelitis. The risks of osteomyelitis in SLE patients were analyzed with Cox proportional hazards regression models, including age, sex, comorbidities and medications.
Results From 2000 to 2012, we identified 18472 SLE patients (88.6% women, mean age of 37.5 years) and 73888 control patients. Compared with the controls, the osteomyelitis incidence rate ratio (IRR) (95% CIs) among all SLE patients were 8.23 (6.76–10.05). The IRR between young SLE patients (18–40 years) and their controls was 22.87 (15.59–34.44). Multivariable Cox regression analyses in SLE patients indicated that older age, being male, with disease of peripheral artery disease (PAOD), chronic kidney disease (CKD), bone fracture, performing orthopedic surgery in recent 6 months, and daily prednisolone equivalent to or more than 7.5 mg are strongly related to osteomyelitis. In contrast, the use of hydroxychloroquine was a protective factor for osteomyelitis.
Conclusions SLE patients had a higher incidence rate of osteomyelitis, especially those who were older, male, had history of PAOD, CKD, bone fracture and orthopedic surgery and used a high dose of corticosteroid.
Wu, K.C., et al., Osteomyelitis in patients with systemic lupus erythematosus. J Rheumatol, 2004. 31(7): p. 1340–3.
Danza, A. and G. Ruiz-Irastorza, Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies. Lupus, 2013. 22(12): p. 1286–94.
Disclosure of Interest None declared