Systemic lupus erythematosus patients with high disease activity are associated with accelerated incidence of osteonecrosis: a systematic review and meta-analysis.

Osteonecrosis (ON) is one of the serious complications for systemic lupus erythematosus (SLE); we aimed to study the risk relationship between disease activity and incidence of ON in SLE patients. The PubMed, Embase, and Cochrane library databases were searched for papers published up to May 2016 with English-language restriction; studies that compared disease activity between SLE patients with and without ON would be included, and eight studies involving a total of 1119 SLE patients were included. The incidence of ON in SLE was significantly associated with high patient's disease activity, including the degree (pool odds ratio 2.54, 95% confidence interval [CI] [1.33, 4.86], p = 0.005) and the scores (mean difference 2.33, 95% CI [0.86, 3.80], p = 0.002). Besides, immunosuppressive drug use was also a significant risk factor for ON (p = 0.00001), while antimalarial treatment played a protective role (p = 0.01). No evidence of publication bias was detected. In conclusion, disease activity is a significant and independent risk factor for ON, and higher disease activity score is associated with accelerated incidence of ON in SLE patients.