Incidence and aggravation of cervical spine instabilities in rheumatoid arthritis: A prospective minimum 5-year follow-up study of patients initially without cervical involvement

Takashi Yurube, Masatoshi Sumi, Kotaro Nishida, Hiroshi Miyamoto, Kozo Kohyama, Tsukasa Matsubara, Yasushi Miura, Daisuke Sugiyama, Minoru Doita

Research output: Contribution to journalArticle

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Abstract

STUDY DESIGN. A prospective minimum 5-year follow-up study of the cervical spine in patients with rheumatoid arthritis (RA) initially without cervical involvement. OBJECTIVE. To clarify the incidence and aggravation of cervical spine instabilities and their predictive risk factors in patients with RA. SUMMARY OF BACKGROUND DATA. Many reports have shown the progression of cervical spine involvement in RA. However, few articles have described comprehensive evaluation of its prognostic factors. METHODS. A total of 140 patients with "definite" or "classical" RA initially without cervical involvement were prospectively followed for more than 5 years. Radiographical cervical findings were classified into 3 instabilities: atlantoaxial subluxation (AAS: atlantodental interval >3 mm), vertical subluxation (VS: Ranawat value <13 mm), and subaxial subluxation (SAS: irreducible translation ≥2 mm). "Severe" extents were defined as AAS with atlantodental interval 10 mm or more, VS with Ranawat value 10 mm or less, and SAS with translation 4 mm or more or at multiple levels. Incidence of these developments and predictors for "severe" instabilities were investigated. RESULTS. During 6.0 ± 0.5 years, 43.6% of 140 patients developed cervical instabilities: AAS in 32.1%, VS in 11.4%, and SAS in 16.4% with some combinations. "Severe" instabilities were exhibited in 12.9% of patients: AAS in 3.6%, VS in 6.4%, and SAS in 5.0%. Furthermore, 4.3% presented canal stenosis, with 13 mm or less space available for the spinal cord (SAC) due to "severe" AAS or "severe" VS in 2.9% and 12 mm or less SAC due to "severe" SAS in 2.1%. Multivariable logistic regression analysis identified corticosteroid administration, mutilating changes at baseline, and the development of nonmutilating into mutilating changes during the follow-up period correlated with "severe" instabilities (P < 0.05). CONCLUSION. A minimum 5-year follow-up reveals the occurrence of cervical instabilities in 43.6%, "severe" aggravation in 12.9%, and decreased SAC in 4.3% of patients with RA. Characteristics of severe disease activity - established mutilating changes, progressive development into mutilating changes, and potentially concomitant corticosteroid treatment - are indicators for poor prognosis of the cervical spine in RA.

Original languageEnglish
Pages (from-to)2136-2144
Number of pages9
JournalSpine
Volume37
Issue number26
DOIs
Publication statusPublished - 2012 Dec 15
Externally publishedYes

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Rheumatoid Arthritis
Spine
Incidence
Spinal Cord
Adrenal Cortex Hormones
Pathologic Constriction
Logistic Models
Regression Analysis
Therapeutics

Keywords

  • Arthritis
  • Cervical spine
  • Clinical course
  • Corticosteroids
  • Instability
  • Mutilans
  • Myelopathy
  • Natural history
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Incidence and aggravation of cervical spine instabilities in rheumatoid arthritis : A prospective minimum 5-year follow-up study of patients initially without cervical involvement. / Yurube, Takashi; Sumi, Masatoshi; Nishida, Kotaro; Miyamoto, Hiroshi; Kohyama, Kozo; Matsubara, Tsukasa; Miura, Yasushi; Sugiyama, Daisuke; Doita, Minoru.

In: Spine, Vol. 37, No. 26, 15.12.2012, p. 2136-2144.

Research output: Contribution to journalArticle

Yurube, Takashi ; Sumi, Masatoshi ; Nishida, Kotaro ; Miyamoto, Hiroshi ; Kohyama, Kozo ; Matsubara, Tsukasa ; Miura, Yasushi ; Sugiyama, Daisuke ; Doita, Minoru. / Incidence and aggravation of cervical spine instabilities in rheumatoid arthritis : A prospective minimum 5-year follow-up study of patients initially without cervical involvement. In: Spine. 2012 ; Vol. 37, No. 26. pp. 2136-2144.
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title = "Incidence and aggravation of cervical spine instabilities in rheumatoid arthritis: A prospective minimum 5-year follow-up study of patients initially without cervical involvement",
abstract = "STUDY DESIGN. A prospective minimum 5-year follow-up study of the cervical spine in patients with rheumatoid arthritis (RA) initially without cervical involvement. OBJECTIVE. To clarify the incidence and aggravation of cervical spine instabilities and their predictive risk factors in patients with RA. SUMMARY OF BACKGROUND DATA. Many reports have shown the progression of cervical spine involvement in RA. However, few articles have described comprehensive evaluation of its prognostic factors. METHODS. A total of 140 patients with {"}definite{"} or {"}classical{"} RA initially without cervical involvement were prospectively followed for more than 5 years. Radiographical cervical findings were classified into 3 instabilities: atlantoaxial subluxation (AAS: atlantodental interval >3 mm), vertical subluxation (VS: Ranawat value <13 mm), and subaxial subluxation (SAS: irreducible translation ≥2 mm). {"}Severe{"} extents were defined as AAS with atlantodental interval 10 mm or more, VS with Ranawat value 10 mm or less, and SAS with translation 4 mm or more or at multiple levels. Incidence of these developments and predictors for {"}severe{"} instabilities were investigated. RESULTS. During 6.0 ± 0.5 years, 43.6{\%} of 140 patients developed cervical instabilities: AAS in 32.1{\%}, VS in 11.4{\%}, and SAS in 16.4{\%} with some combinations. {"}Severe{"} instabilities were exhibited in 12.9{\%} of patients: AAS in 3.6{\%}, VS in 6.4{\%}, and SAS in 5.0{\%}. Furthermore, 4.3{\%} presented canal stenosis, with 13 mm or less space available for the spinal cord (SAC) due to {"}severe{"} AAS or {"}severe{"} VS in 2.9{\%} and 12 mm or less SAC due to {"}severe{"} SAS in 2.1{\%}. Multivariable logistic regression analysis identified corticosteroid administration, mutilating changes at baseline, and the development of nonmutilating into mutilating changes during the follow-up period correlated with {"}severe{"} instabilities (P < 0.05). CONCLUSION. A minimum 5-year follow-up reveals the occurrence of cervical instabilities in 43.6{\%}, {"}severe{"} aggravation in 12.9{\%}, and decreased SAC in 4.3{\%} of patients with RA. Characteristics of severe disease activity - established mutilating changes, progressive development into mutilating changes, and potentially concomitant corticosteroid treatment - are indicators for poor prognosis of the cervical spine in RA.",
keywords = "Arthritis, Cervical spine, Clinical course, Corticosteroids, Instability, Mutilans, Myelopathy, Natural history, Rheumatoid arthritis",
author = "Takashi Yurube and Masatoshi Sumi and Kotaro Nishida and Hiroshi Miyamoto and Kozo Kohyama and Tsukasa Matsubara and Yasushi Miura and Daisuke Sugiyama and Minoru Doita",
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T1 - Incidence and aggravation of cervical spine instabilities in rheumatoid arthritis

T2 - A prospective minimum 5-year follow-up study of patients initially without cervical involvement

AU - Yurube, Takashi

AU - Sumi, Masatoshi

AU - Nishida, Kotaro

AU - Miyamoto, Hiroshi

AU - Kohyama, Kozo

AU - Matsubara, Tsukasa

AU - Miura, Yasushi

AU - Sugiyama, Daisuke

AU - Doita, Minoru

PY - 2012/12/15

Y1 - 2012/12/15

N2 - STUDY DESIGN. A prospective minimum 5-year follow-up study of the cervical spine in patients with rheumatoid arthritis (RA) initially without cervical involvement. OBJECTIVE. To clarify the incidence and aggravation of cervical spine instabilities and their predictive risk factors in patients with RA. SUMMARY OF BACKGROUND DATA. Many reports have shown the progression of cervical spine involvement in RA. However, few articles have described comprehensive evaluation of its prognostic factors. METHODS. A total of 140 patients with "definite" or "classical" RA initially without cervical involvement were prospectively followed for more than 5 years. Radiographical cervical findings were classified into 3 instabilities: atlantoaxial subluxation (AAS: atlantodental interval >3 mm), vertical subluxation (VS: Ranawat value <13 mm), and subaxial subluxation (SAS: irreducible translation ≥2 mm). "Severe" extents were defined as AAS with atlantodental interval 10 mm or more, VS with Ranawat value 10 mm or less, and SAS with translation 4 mm or more or at multiple levels. Incidence of these developments and predictors for "severe" instabilities were investigated. RESULTS. During 6.0 ± 0.5 years, 43.6% of 140 patients developed cervical instabilities: AAS in 32.1%, VS in 11.4%, and SAS in 16.4% with some combinations. "Severe" instabilities were exhibited in 12.9% of patients: AAS in 3.6%, VS in 6.4%, and SAS in 5.0%. Furthermore, 4.3% presented canal stenosis, with 13 mm or less space available for the spinal cord (SAC) due to "severe" AAS or "severe" VS in 2.9% and 12 mm or less SAC due to "severe" SAS in 2.1%. Multivariable logistic regression analysis identified corticosteroid administration, mutilating changes at baseline, and the development of nonmutilating into mutilating changes during the follow-up period correlated with "severe" instabilities (P < 0.05). CONCLUSION. A minimum 5-year follow-up reveals the occurrence of cervical instabilities in 43.6%, "severe" aggravation in 12.9%, and decreased SAC in 4.3% of patients with RA. Characteristics of severe disease activity - established mutilating changes, progressive development into mutilating changes, and potentially concomitant corticosteroid treatment - are indicators for poor prognosis of the cervical spine in RA.

AB - STUDY DESIGN. A prospective minimum 5-year follow-up study of the cervical spine in patients with rheumatoid arthritis (RA) initially without cervical involvement. OBJECTIVE. To clarify the incidence and aggravation of cervical spine instabilities and their predictive risk factors in patients with RA. SUMMARY OF BACKGROUND DATA. Many reports have shown the progression of cervical spine involvement in RA. However, few articles have described comprehensive evaluation of its prognostic factors. METHODS. A total of 140 patients with "definite" or "classical" RA initially without cervical involvement were prospectively followed for more than 5 years. Radiographical cervical findings were classified into 3 instabilities: atlantoaxial subluxation (AAS: atlantodental interval >3 mm), vertical subluxation (VS: Ranawat value <13 mm), and subaxial subluxation (SAS: irreducible translation ≥2 mm). "Severe" extents were defined as AAS with atlantodental interval 10 mm or more, VS with Ranawat value 10 mm or less, and SAS with translation 4 mm or more or at multiple levels. Incidence of these developments and predictors for "severe" instabilities were investigated. RESULTS. During 6.0 ± 0.5 years, 43.6% of 140 patients developed cervical instabilities: AAS in 32.1%, VS in 11.4%, and SAS in 16.4% with some combinations. "Severe" instabilities were exhibited in 12.9% of patients: AAS in 3.6%, VS in 6.4%, and SAS in 5.0%. Furthermore, 4.3% presented canal stenosis, with 13 mm or less space available for the spinal cord (SAC) due to "severe" AAS or "severe" VS in 2.9% and 12 mm or less SAC due to "severe" SAS in 2.1%. Multivariable logistic regression analysis identified corticosteroid administration, mutilating changes at baseline, and the development of nonmutilating into mutilating changes during the follow-up period correlated with "severe" instabilities (P < 0.05). CONCLUSION. A minimum 5-year follow-up reveals the occurrence of cervical instabilities in 43.6%, "severe" aggravation in 12.9%, and decreased SAC in 4.3% of patients with RA. Characteristics of severe disease activity - established mutilating changes, progressive development into mutilating changes, and potentially concomitant corticosteroid treatment - are indicators for poor prognosis of the cervical spine in RA.

KW - Arthritis

KW - Cervical spine

KW - Clinical course

KW - Corticosteroids

KW - Instability

KW - Mutilans

KW - Myelopathy

KW - Natural history

KW - Rheumatoid arthritis

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