Acta Ortopédica Mexicana

Geraldo-Flores NA, Merlos-López RJ, Rodríguez-Wong JA, Ramírez-Hernández S, Espino-Lizarraga MJ, Pérez-Atanasio JM
The severity of rheumatoid arthritis as a timely predictor of instability in the asymptomatic cervical spine
Acta Ortop Mex 2018; 32 (6)

Language: Espańol
References: 13
Page: 342-346
PDF: 203.89 Kb.

[Fulltext - PDF]

ABSTRACT

Introduction: Cervical spine involvement is common in patients with RA, risk factors such as disease activity may be related to asymptomatic cervical instability. Objective: To determine the associated factors for asymptomatic cervical spine instability in patients with rheumatoid arthritis. Material and methods: Case and control study from the external spine and rheumatology consultation of a level II trauma center to identify all patients diagnosed with rheumatoid arthritis (RA) and asymptomatic cervical instability. With simple X-rays of the cervical spine, carrying out radiographic measurements, the diagnosis of cervical instability was performed, risk factors such as the presence of rheumatoid factor (FR), previous articular surgeries, elevations of the C-reactive protein (PCR) values were evaluated. The severity and activity of the disease measured in the activity index of 28 articulations (DAS 28) in addition to the index of activity of the simplified disease (SDAI). Results: We assessed 32 patients, nine patients (28.1%) met the criteria for instability of the anterior cervical spine atlantoaxial subluxation (SAAa) (100%), also one patient with SAAa presented vertical subluxation (SV), risk factors more relevant: DAS 28 with an OR = 3.54, SDA with an OR = 2.34 and finally the PCR › 1.0 its OR = 2.88. Conclusion: The risk factors associated opportunely in our population are the severity of the activity of the disease that we can see in the DAS and SDAI when applied in patients and PCR › 1.0.


Key words: Cervical spine, instability, rheumatoid arthritis, atlantic-axial articulation, risk factors.


REFERENCES

  1. Mańczak M, Gasik R. Cervical spine instability in the course of rheumatoid arthritis - imaging methods. Reumatologia. 2017; 55(4): 201-7.

  2. Kaito T, Ohshima S, Fujiwara H, Makino T, Yonenobu K. Predictors for the progression of cervical lesion in rheumatoid arthritis under the treatment of biological agents. Spine (Phila Pa 1976). 2013; 38(26): 2258-63.

  3. Del Grande M, Del Grande F, Carrino J, Bingham CO 3rd, Louie GH. Cervical spine involvement early in the course of rheumatoid arthritis. Semin Arthritis Rheum. 2014; 43(6): 738-44.

  4. Kaito T, Hosono N, Ohshima S, Ohwaki H, Takenaka S, Fujiwara H, et al. Effect of biological agents on cervical spine lesions in rheumatoid arthritis. Spine (Phila Pa 1976). 2012; 37(20): 1742-6.

  5. Na MK, Chun HJ, Bak KH, Yi HJ, Ryu JI, Han MH. Risk factors for the development and progression of atlantoaxial subluxation in surgically treated rheumatoid arthritis patients, considering the time interval between rheumatoid arthritis diagnosis and surgery. J Korean Neurosurg Soc. 2016; 59(6): 590-6.

  6. Cha TD, An HS. Cervical spine manifestations in patients with inflammatory arthritides. Nat Rev Rheumatol. 2013; 9(7): 423-32.

  7. Terashima Y, Yurube T, Hirata H, Sugiyama D, Sumi M; Hyogo Organization of Spinal Disorders. Predictive risk factors of cervical spine instabilities in rheumatoid arthritis: a prospective multicenter over 10-year cohort study. Spine (Phila Pa 1976). 2017; 42(8): 556-64.

  8. Zhu S, Xu W, Luo Y, Zhao Y, Liu Y. Cervical spine involvement risk factors in rheumatoid arthritis: a meta-analysis. Int J Rheum Dis. 2017; 20(5): 541-9.

  9. Han MH, Ryu JI, Kim CH, Kim JM, Cheong JH, Bak KH, et al. Factors that predict risk of cervical instability in rheumatoid arthritis patients. Spine (Phila Pa 1976). 2017; 42(13): 966-73.

  10. Collins DN, Barnes CL, FitzRandolph RL. Cervical spine instability in rheumatoid patients having total hip or knee arthroplasty. Clin Orthop Relat Res. 1991; (272): 127-35.

  11. Nazarinia M, Jalli R, Kamali-Sarvestani E, Farahangiz S, Ataollahi M. Asymptomatic atlantoaxial subluxation in rheumatoid arthritis. Acta Med Iran. 2014; 52(6): 462-6.

  12. Neva MH, Häkkinen A, Mäkinen H, Hannonen P, Kauppi M, Sokka T. High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery. Ann Rheum Dis. 2006; 65(7): 884-8.

  13. Zhang T, Pope J. Cervical spine involvement in rheumatoid arthritis over time: results from a meta-analysis. Arthritis Res Ther. 2015; 17: 148.