SLE — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeSLESCE Rheumatology

A 38-year-old woman with systemic lupus erythematosus develops atraumatic osteonecrosis of the femoral head. Which of the following factors most strongly increases the risk of this complication in patients with SLE?

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Correct answer: A — High-dose systemic glucocorticoid therapy

The correct answer is high-dose systemic glucocorticoid therapy. Osteonecrosis in SLE is most strongly predicted by glucocorticoid intensity — high initial, peak or sustained daily doses (for example prednisone 20–39 mg/day for over a month, or 40 mg/day even briefly) — rather than by lifetime cumulative dose alone, which is why the option wording specifies dose intensity. Antiphospholipid antibodies, Raynaud phenomenon and vasculitis modify risk but are not offered. Anti-dsDNA positivity reflects immunological activity and prompts steroid use but does not independently predict osteonecrosis. Anti-Ro relates chiefly to cutaneous, neonatal lupus and congenital heart block. Longer disease duration correlates with treatment exposure but is not itself decisive. Hydroxychloroquine is foundational SLE therapy and is not a cause. EULAR 2023 accordingly urges minimising glucocorticoids to ≤5 mg/day prednisolone equivalent and withdrawing where possible.

Reference: Kallas R, Li J, Petri M. Predictors of Osteonecrosis in Systemic Lupus Erythematosus: A Prospective Cohort Study. Arthritis Care Res (Hoboken). 2022;74(7):1122-1132. https://pubmed.ncbi.nlm.nih.gov/33342072/