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Incidence and Aggravation of Cervical Spine Instabilities in Rheumatoid Arthritis: A Prospective Minimum 5-Year Follow-Up Study of Patients Initially without Cervical Involvement.
MedLine Citation:
PMID:  22895480     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
STRUCTURED ABSTRACT: Study Design. A prospective minimum 5-year follow-up study of the cervical spine in rheumatoid arthritis (RA) patients 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 papers have described comprehensive evaluation of its prognostic factors.Methods. 140 "definite" or "classical" RA patients initially without cervical involvement were prospectively followed for over 5 years. Radiographic cervical findings were classified into three instabilities: atlantoaxial subluxation (AAS: atlantodental interval [ADI]>3 mm), vertical subluxation (VS: Ranawat value<13 mm), and subaxial subluxation (SAS: irreducible translation≥2 mm). "Severe" extents were defined as AAS with ADI≥10 mm, VS with Ranawat value≤10 mm, and SAS with translation≥4 mm 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. 12.9% exhibited "severe" instabilities: AAS in 3.6%, VS in 6.4%, and SAS in 5.0%. Furthermore, 4.3% presented canal stenosis with space available for the spinal cord (SAC)≤13 mm due to "severe" AAS or "severe" VS in 2.9% and SAC≤12 mm due to "severe" SAS in 2.1%. Multivariable logistic regression analysis identified corticosteroid administration, mutilating changes at baseline, and the development of non-mutilating 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 RA patients. 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.
Authors:
Takashi Yurube; Masatoshi Sumi; Kotaro Nishida; Hiroshi Miyamoto; Kozo Kohyama; Tsukasa Matsubara; Yasushi Miura; Daisuke Sugiyama; Minoru Doita;
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-14
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan 2Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan 3Department of Orthopaedic Surgery, Kobe Medical Center, Kobe, Japan 4Department of Orthopaedic Surgery, Kohnan Kakogawa Hospital, Kakogawa, Japan 5Department of Orthopaedic Surgery, Matsubara Mayflower Hospital, Kato, Japan 6Department of Evidence-Based Laboratory Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
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