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Spine (Phila Pa 1976). 2011 Apr 15;36(8):647-53. doi: 10.1097/BRS.0b013e3181da21c5.

Progression of cervical spine instabilities in rheumatoid arthritis: a prospective cohort study of outpatients over 5 years.

Author information

1
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan.

Abstract

STUDY DESIGN:

A 5-year prospective cohort study of cervical spine instabilities in rheumatoid arthritis (RA). OBJECTIVE.: To clarify the natural course of cervical instabilities in RA patients and to determine predictors for the prognosis of RA cervical spine.

SUMMARY OF BACKGROUND DATA:

Although several previous studies investigating the natural history of RA cervical spine have been reported, few of them have described radiological predictive factors for the aggravation of these instabilities.

METHODS:

Two hundred sixty-seven outpatients with "definite" or "classical" RA initially assigned were prospectively followed for over 5 years. Radiographic cervical findings were classified into three representative instabilities: atlantoaxial subluxation (AAS), vertical subluxation (VS), and subaxial subluxation (SAS). The aggravations of these instabilities were identified in the cases with a decrease of at least 2 mm in the Ranawat value of VS, an increase of at least 1 mm in translation of SAS, or a new development of respective instabilities. RA stages and mutilating changes were assessed in the hand radiograms.

RESULTS:

Fifty-two point four percent of 267 patients, without any cervical instability at the beginning of follow-up, decreased to 29.6% at the end (P < 0.01), whereas VS and SAS increased significantly (P < 0.01). The aggravation of VS was observed at statistically higher rates in patients with pre-existing instabilities as follows; 25.7% of AAS (P = 0.01), 49.1% of VS (P < 0.01), and 41.2% of SAS (P = 0.06). The aggravation of SAS was also detected in 47.2% of VS and 64.7% of SAS (P < 0.01). Patients with pre-existing mutilating changes exhibited the aggravations of VS and SAS in significantly higher incidences (P < 0.01). Furthermore, the cases with development into mutilating changes during the follow-up showed significantly higher tendencies for the aggravations of these instabilities (P < 0.01).

CONCLUSION:

The incidences of VS and SAS significantly increased during the minimum 5-year follow-up. Prognostic factors of these instabilities were revealed to be the initial radiological findings of VS, SAS, and mutilating changes.

PMID:
21178849
DOI:
10.1097/BRS.0b013e3181da21c5
[Indexed for MEDLINE]

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