Yamada Kentaro, Suzuki Akinobu, Takahashi Shinji, Yasuda Hiroyuki, Koike Tatsuya, Nakamura Hiroaki
Department of Orthopaedic Surgery, Osaka City University Medical School , Osaka , Japan.
Mod Rheumatol. 2015 Jan;25(1):56-61. doi: 10.3109/14397595.2014.924187. Epub 2014 Jun 19.
To investigate the prevalence and associated factors of severe low back pain (LBP) among patients with rheumatoid arthritis (RA).
This cross-sectional study included 201 patients with RA without prior spinal surgery. Severe LBP was defined as that with a visual analog scale (VAS) score of ≥ 50 mm within the previous 4 weeks. Lumbar lesions, sagittal alignment, and disc degeneration were evaluated by plain standing X-rays and magnetic resonance imaging. Associated factors of severe LBP were evaluated using multiple logistic regression analysis.
Forty-eight patients (23.8%) had LBP with a VAS score of ≥ 50 mm. Multivariate analysis indicated that the associated factors for severe LBP were female, smoking, and moderate and high disease activity on the Disease Activity Score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR). There was no relationship between severe LBP and any radiological findings. Among DAS28-ESR subscores, patients with severe LBP had significantly higher tender joint counts and VAS scores for general health.
The prevalence of severe LBP was relatively high in patients with RA. The factor most closely associated with severe LBP was Disease Activity Score, but not radiological findings. Severe LBP was related to the tender joint count or subjective complaints of RA.
探讨类风湿关节炎（RA）患者中严重腰痛（LBP）的患病率及相关因素。
这项横断面研究纳入了201例未曾接受过脊柱手术的RA患者。严重LBP定义为在过去4周内视觉模拟量表（VAS）评分≥50 mm。通过站立位X线平片和磁共振成像评估腰椎病变、矢状位排列和椎间盘退变情况。采用多因素logistic回归分析评估严重LBP的相关因素。
48例患者（23.8%）的LBP的VAS评分≥50 mm。多因素分析表明，严重LBP的相关因素为女性、吸烟以及基于28个关节疾病活动评分-红细胞沉降率（DAS28-ESR）的中度和高度疾病活动度。严重LBP与任何影像学表现均无关联。在DAS28-ESR各亚评分中，严重LBP患者的压痛关节数和总体健康状况的VAS评分显著更高。
RA患者中严重LBP的患病率相对较高。与严重LBP关系最密切的因素是疾病活动评分，而非影像学表现。严重LBP与RA的压痛关节数或主观症状相关。
