Neva Marko Henrik, Isomäki Pia, Hannonen Pekka, Kauppi Markku, Krishnan Eswar, Sokka Tuulikki
Division of Orthopaedic and Trauma Surgery, Department of Surgery,Tampere University Hospital, Tampere, Finland.
Arthritis Rheum. 2003 Jul;48(7):1808-13. doi: 10.1002/art.11086.
To study the prevalence of cervical spine subluxations and predictive factors for atlantoaxial subluxations (including anterior atlantoaxial subluxation and atlantoaxial impaction, i.e., vertical subluxation) in patients with rheumatoid arthritis (RA) who were treated early and continuously with disease-modifying antirheumatic drugs for 8-13 years.
Radiographs of the cervical spine were obtained in 103 of 110 patients (the 110 surviving patients of the original 135-patient cohort) at their 8-13-year followup visits. The prevalence of cervical spine subluxations was determined. Demographic variables and the first 5-year serial data concerning disease course were analyzed in a logistic regression model to find predictive factors for atlantoaxial subluxations.
Atlantoaxial subluxations were found in 14 patients (14%), and 5 patients (5%) had subaxial subluxations. Older age at baseline, greater disease activity during the first 5 years, and early erosiveness in peripheral joints predicted the development of atlantoaxial subluxations. Patients who had >or=10% of the maximum possible radiographic damage (by Larsen score) in peripheral joints at 5 years were 15.9 times more likely to develop atlantoaxial subluxations at 8-13 years than patients whose peripheral joint damage remained <10% of the maximum.
Compared with historical control RA cohorts, a lower prevalence of cervical spine destruction was found in the present group of patients. Rapid erosiveness in peripheral joints was the best predictor for atlantoaxial subluxations. Extensive erosiveness in peripheral joints should alert rheumatologists to the possible development of atlantoaxial subluxations in patients with RA.
研究类风湿关节炎（RA）患者早期并持续使用改善病情抗风湿药物治疗8至13年后颈椎半脱位的患病率以及寰枢椎半脱位（包括寰枢椎前脱位和寰枢椎撞击，即垂直半脱位）的预测因素。
在110例患者（原135例患者队列中的110例存活患者）的8至13年随访中，对其中103例患者进行了颈椎X线片检查。确定颈椎半脱位的患病率。在逻辑回归模型中分析人口统计学变量和有关病程的前5年系列数据，以寻找寰枢椎半脱位的预测因素。
14例患者（14%）发现有寰枢椎半脱位，5例患者（5%）有下颈椎半脱位。基线时年龄较大、前5年疾病活动度较高以及外周关节早期出现侵蚀性病变可预测寰枢椎半脱位的发生。5年时外周关节放射学损伤（根据Larsen评分）达到或超过最大可能损伤的10%的患者，在8至13年时发生寰枢椎半脱位的可能性是外周关节损伤仍小于最大损伤10%的患者的15.9倍。
与历史对照的RA队列相比，本研究组患者颈椎破坏的患病率较低。外周关节快速出现侵蚀性病变是寰枢椎半脱位的最佳预测因素。外周关节广泛的侵蚀性病变应提醒风湿病学家注意RA患者可能发生寰枢椎半脱位。
