*Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Departments of †Rheumatology; and ‡Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan; and §Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan.
Spine (Phila Pa 1976). 2013 Dec 15;38(26):2258-63. doi: 10.1097/BRS.0000000000000066.
Retrospective cohort analysis.
To clarify the effect of biological agents (BAs) on the development and progression of cervical lesions in patients with rheumatoid arthritis (RA) and to identify biomarkers that accurately predict disease progression.
The introduction of BAs changed the paradigm of RA treatment. However, their effects on cervical lesions in patients with RA have not been studied.
Ninety-one subjects who had received BAs for 2 years or more were enrolled. Mean radiographical interval was 3.9 years. Disease activity was evaluated by disease activity score-C-reactive protein levels, and matrix metalloproteinase-3 levels. Cervical lesions were defined as an atlantodental interval more than 3 mm for atlantoaxial subluxation (AAS), Ranawat value less than 13 mm for vertical subluxation (VS), and anterior or posterior listhesis more than 2 mm for subaxial subluxation. Disease progression was defined radiographically as an increase in the atlantodental interval more than 2 mm for AAS, a decrease in both Ranawat and Redlund-Johnell values more than 2 mm for VS, and an increase in listhesis more than 2 mm for subaxial subluxation. We used multivariate regression techniques to assess predictors of disease progression.
Baseline radiographical evaluation showed no pre-existing cervical lesion in 44 patients, AAS in 29, and VS in 18. Radiological progression occurred in 7% patients without baseline lesions, 79% in the AAS group, and 72% in the VS group. The incidence of progression was significantly lower in patients without lesions at baseline. Multivariate regression analysis demonstrated pre-existing cervical lesions, disease activity score-C-reactive protein levels at baseline and metalloproteinase-3 levels at final visit as good predictors of RA progression.
BAs prevented de novo cervical lesions in patients with RA but failed to control progression in patients with pre-existing cervical lesions. Disease activity score-C-reactive protein levels at baseline were related to pre-existing joint destruction, and metalloproteinase-3 levels accurately predicted ongoing bone destruction during BA treatment.
回顾性队列分析。
阐明生物制剂（BAs）对类风湿关节炎（RA）患者宫颈病变的发展和进展的影响，并确定准确预测疾病进展的生物标志物。
BAs 的引入改变了 RA 治疗的模式。然而，它们对 RA 患者宫颈病变的影响尚未得到研究。
共纳入 91 例接受 BA 治疗 2 年或以上的患者。平均影像学随访间隔为 3.9 年。疾病活动度通过疾病活动评分-C 反应蛋白（CRP）水平和基质金属蛋白酶-3（MMP-3）水平进行评估。颈椎病变定义为寰枢椎半脱位（AAS）的寰齿间距大于 3mm，垂直半脱位（VS）的 Ranawat 值小于 13mm，下颈椎半脱位的前后滑脱大于 2mm。影像学进展定义为 AAS 的寰齿间距增加大于 2mm，VS 的 Ranawat 和 Redlund-Johnell 值减少大于 2mm，下颈椎半脱位的滑脱增加大于 2mm。我们使用多变量回归技术评估疾病进展的预测因素。
基线影像学评估显示，44 例患者无颈椎病变，29 例患者存在 AAS，18 例患者存在 VS。7%的无基线病变患者出现影像学进展，79%的 AAS 组和 72%的 VS 组出现进展。基线无病变患者的进展发生率明显较低。多变量回归分析表明，基线存在颈椎病变、基线时的疾病活动评分-CRP 水平和最后一次就诊时的 MMP-3 水平是 RA 进展的良好预测因素。
BA 预防了 RA 患者的新发性颈椎病变，但未能控制基线存在颈椎病变患者的病变进展。基线疾病活动评分-CRP 水平与基线关节破坏有关，MMP-3 水平准确预测了 BA 治疗期间的持续骨破坏。
3 级。
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