Objective:

To investigate the factors related to osteonecrosis (ON) in patients with systemic lupus erythematosus (SLE) and provide a basis for early prevention and control.

Approach:

• Literature Search: A comprehensive search of relevant literature was conducted across multiple databases, assessing 3,051 studies for inclusion based on specific criteria.
• Meta-Analysis: 64 studies were included in the meta-analysis to evaluate associations between various factors and SLE-ON.

Key Findings:

• Neuropsychiatric lupus (OR = 1.652), hyperlipidemia (OR = 1.358), oral ulcers (OR = 1.319), pleuritis (OR = 2.225), malar rash (OR = 1.311), vasculitis (OR = 2.638), serositis (OR = 1.514), hematologic involvement (OR = 1.190), Reynaud’s phenomenon (OR = 1.604), thrombophlebitis (OR = 1.856), and arthritis (OR = 1.256) are positively related to SLE-ON risk.
• Laboratory features such as proteinuria (OR = 1.635) and antiphospholipid antibody (OR = 1.450) are also positively associated with SLE-ON.
• Cyclophosphamide (OR = 1.869) and steroid pulse therapy (OR = 1.829) correlate positively with SLE-ON occurrence.
• Younger age (SMD=−0.175) and age at onset (SMD=−0.426) are significantly related to the development of SLE-ON.
• Anti-SSA (OR = 0.805) and anti-SSB antibodies (OR = 0.764) are negatively related to SLE-ON susceptibility.

Interpretation:

A total of 32 factors, including clinical, laboratory features, drug usage, and basic information, are related to SLE complicated with osteonecrosis. The association between cyclophosphamide/steroid pulse therapy and SLE-ON risk may be confounded by underlying disease severity.

Limitations:

• Heterogeneity in study designs, sample sizes, and diagnostic criteria may affect the consistency of results.
• Interpretation of results regarding drug usage and SLE-ON risk should be approached with caution due to potential confounding factors.

Conclusion:

Identifying and managing modifiable risk factors may help reduce SLE-ON risk.