Incidence and risk factors of osteomyelitis in adult and pediatric systemic lupus erythematosus

a nationwide, population-based cohort study

Y F Huang, Y S Chang, W S Chen, Y P Tsao, W H Wang, H T Liao, C Y Tsai, C C Lai

Research output: Contribution to journalArticle

Abstract

Objective: The objective of this paper is to investigate the incidence rate, risk factors and outcome of osteomyelitis among patients with systemic lupus erythematosus (SLE). Materials and methods: We conducted a cohort study using data for patients enrolled in the Taiwan National Health Insurance Database from 2000 to 2012. Patients with SLE and age- and sex-matched controls without SLE were enrolled. Primary endpoint was the first occurrence of osteomyelitis. Risks of osteomyelitis in SLE patients were analyzed with Cox proportional hazards regression models, including age, sex, comorbidities and medications. Results: Among 24,705 SLE patients (88.4% women, mean age 35.8 years) with a median follow-up of 9.1 years, 386 patients had osteomyelitis. The incidence rate ratio (IRR) of osteomyelitis in the SLE group vs the control group was 8.52 (95% confidence interval (CI) 7.24–10.05). The SLE group had higher incidence rates of osteomyelitis than the control group, especially in pediatric subgroups (IRR 41.1 95% CI 18.57–107.35). Compared to controls, SLE patients experienced osteomyelitis at a younger age (42.3 vs 58.1 years) but did not have an increased risk of mortality (hazard ratio 0.7; 95% CI 0.21–2.38). Age >60 years, male gender, malignancy within five years, prior bone fracture and higher daily prednisolone dose (>7.5 mg) cumulatively for >180 days increased risk for osteomyelitis. Conclusions: SLE patients have a higher IRR of osteomyelitis than controls. Pediatric and elder SLE patients, patients with a history of bone fracture, malignancy within five years and higher-dose glucocorticoid use have a higher risk of osteomyelitis and should be carefully monitored.

Original languageEnglish
Pages (from-to)19-26
Number of pages8
JournalLupus
Volume28
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Osteomyelitis
Systemic Lupus Erythematosus
Cohort Studies
Pediatrics
Incidence
Population
Bone Fractures
Confidence Intervals
Control Groups
National Health Programs
Prednisolone
Taiwan
Proportional Hazards Models
Glucocorticoids
Comorbidity
Neoplasms
Databases
Mortality

Keywords

  • Incidence rate
  • osteomyelitis
  • risk factor
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Rheumatology

Cite this

Incidence and risk factors of osteomyelitis in adult and pediatric systemic lupus erythematosus : a nationwide, population-based cohort study. / Huang, Y F; Chang, Y S; Chen, W S; Tsao, Y P; Wang, W H; Liao, H T; Tsai, C Y; Lai, C C.

In: Lupus, Vol. 28, No. 1, 01.01.2019, p. 19-26.

Research output: Contribution to journalArticle

Huang, Y F ; Chang, Y S ; Chen, W S ; Tsao, Y P ; Wang, W H ; Liao, H T ; Tsai, C Y ; Lai, C C. / Incidence and risk factors of osteomyelitis in adult and pediatric systemic lupus erythematosus : a nationwide, population-based cohort study. In: Lupus. 2019 ; Vol. 28, No. 1. pp. 19-26.
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AU - Tsao, Y P

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AB - Objective: The objective of this paper is to investigate the incidence rate, risk factors and outcome of osteomyelitis among patients with systemic lupus erythematosus (SLE). Materials and methods: We conducted a cohort study using data for patients enrolled in the Taiwan National Health Insurance Database from 2000 to 2012. Patients with SLE and age- and sex-matched controls without SLE were enrolled. Primary endpoint was the first occurrence of osteomyelitis. Risks of osteomyelitis in SLE patients were analyzed with Cox proportional hazards regression models, including age, sex, comorbidities and medications. Results: Among 24,705 SLE patients (88.4% women, mean age 35.8 years) with a median follow-up of 9.1 years, 386 patients had osteomyelitis. The incidence rate ratio (IRR) of osteomyelitis in the SLE group vs the control group was 8.52 (95% confidence interval (CI) 7.24–10.05). The SLE group had higher incidence rates of osteomyelitis than the control group, especially in pediatric subgroups (IRR 41.1 95% CI 18.57–107.35). Compared to controls, SLE patients experienced osteomyelitis at a younger age (42.3 vs 58.1 years) but did not have an increased risk of mortality (hazard ratio 0.7; 95% CI 0.21–2.38). Age >60 years, male gender, malignancy within five years, prior bone fracture and higher daily prednisolone dose (>7.5 mg) cumulatively for >180 days increased risk for osteomyelitis. Conclusions: SLE patients have a higher IRR of osteomyelitis than controls. Pediatric and elder SLE patients, patients with a history of bone fracture, malignancy within five years and higher-dose glucocorticoid use have a higher risk of osteomyelitis and should be carefully monitored.

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KW - risk factor

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