Takahashi Shinji, Suzuki Akinobu, Koike Tatsuya, Yamada Kentaro, Yasuda Hiroyuki, Tada Masahiro, Sugioka Yuko, Okano Tadashi, Nakamura Hiroaki
Department of Orthopaedic Surgery, Osaka City University Medical School , Osaka , Japan.
Mod Rheumatol. 2014 Nov;24(6):904-9. doi: 10.3109/14397595.2014.895123. Epub 2014 Mar 26.
Cervical spine instability (CSI) is commonly involved in patients with rheumatoid arthritis (RA). Although the treatment for RA has dramatically changed due to methotrexate and biologics, it is unclear whether this change contributes to the prevalence of CSI or not. Our objectives were to update the current prevalence of CSI and to investigate the factors associated with CSI.
A cross-sectional study of patients with RA was conducted in our outpatient clinic. Clinical information and symptoms related to CSI were obtained. Plain radiography and magnetic resonance imaging were performed. CSI included atlantoaxial subluxation (AAS), vertical subluxation (VS), and subaxial subluxation (SAS).
Two hundred and twenty patients were analyzed, 93 (42%) of whom had CSI. A ≥ 10-year disease duration, Steinbrocker stage III, and three or more narrowed disc spaces from C2/3 to C6/7 were significantly associated with CSI. A neck pain VAS was associated with VS, but not with AAS and SAS. In contrast, methotrexate and biologics had no effect on CSI.
The prevalence of CSI in this study was lower compared to previous reports before the approval of biologic, although we failed to detect the effect of biologics. Further prospective studies are needed to elucidate the efficacy.
类风湿关节炎（RA）患者常伴有颈椎不稳（CSI）。尽管由于甲氨蝶呤和生物制剂的应用，RA的治疗已发生显著变化，但尚不清楚这种变化是否会影响CSI的患病率。我们的目的是更新当前CSI的患病率，并调查与CSI相关的因素。
在我们的门诊对RA患者进行了一项横断面研究。获取了与CSI相关的临床信息和症状。进行了X线平片和磁共振成像检查。CSI包括寰枢椎半脱位（AAS）、垂直半脱位（VS）和下颈椎半脱位（SAS）。
对220例患者进行了分析，其中93例（42%）患有CSI。疾病持续时间≥10年、Steinbrocker III期以及从C2/3至C6/7有三个或更多椎间隙狭窄与CSI显著相关。颈部疼痛视觉模拟评分（VAS）与VS相关，但与AAS和SAS无关。相比之下，甲氨蝶呤和生物制剂对CSI没有影响。
尽管我们未能检测到生物制剂的作用，但本研究中CSI的患病率低于生物制剂获批前的既往报道。需要进一步的前瞻性研究来阐明其疗效。
