Department of Spine and Spinal Cord Surgery, Nagaoka Red Cross Hospital, 2-297-1, Senshu, Nagaoka-City, Niigata, 9402108, Japan.
Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Eur Spine J. 2019 May;28(5):976-982. doi: 10.1007/s00586-019-05938-x. Epub 2019 Mar 8.
To investigate the prevalence of and factors associated with dysfunctional low back pain (LBP) in patients with rheumatoid arthritis (RA).
This cross-sectional study included 1276 RA outpatients from two hospitals. The Roland-Morris Disability Questionnaire was used to address the functional-dysfunctional state criterion. Clinical variables, such as medical status, disease activity, bone mineral density, and spinopelvic alignment parameters, were compared between patients with and without dysfunctional LBP.
Mean age and disease duration were 64.6 and 13.4 years, respectively; the prevalence of dysfunctional LBP was 32.8%. On univariate analysis, significant differences existed in many variables, except sex, body weight, C-reactive protein (CRP) level, and prevalence of biological agent users, between patients with and without dysfunctional LBP. Multivariate logistic regression analysis revealed body mass index (BMI; odds ratio [OR], 1.116; P < 0.001), onset age of RA (OR, 1.020; P = 0.020), disease duration of RA (OR, 1.043; P < 0.001), methotrexate (MTX) use (OR, 0.609; P = 0.007), vertebral fractures (OR, 2.189; P = 0.001), vertebral endplate and/or facet erosion (OR, 1.411; P = 0.043), disease activity score (DAS) in 28 joints-CRP (DAS-28CRP) (OR, 1.587; P = 0.001), pelvic tilt (PT; OR, 1.023; P = 0.019), and sagittal vertical axis (SVA; OR, 1.007; P = 0.043) as associated factors.
The factors associated with dysfunctional LBP in patients with RA were more vertebral fractures, higher DAS-28CRP, vertebral endplate and/or facet erosion, higher BMI, longer disease duration, greater PT, older onset age, greater SVA, and less MTX use. Strictly controlling patients' body weight and disease activity with MTX and avoiding spinopelvic malalignment through vertebral fracture prevention are important. These slides can be retrieved under Electronic Supplementary Material.
探讨类风湿关节炎（RA）患者中功能障碍性下腰痛（LBP）的患病率及相关因素。
本横断面研究纳入了来自两家医院的 1276 例 RA 门诊患者。采用 Roland-Morris 残疾问卷来确定功能-障碍状态标准。比较了有和无功能障碍性 LBP 患者之间的临床变量，如医疗状况、疾病活动度、骨密度和脊柱骨盆排列参数。
平均年龄和病程分别为 64.6 岁和 13.4 年，功能障碍性 LBP 的患病率为 32.8%。在单因素分析中，有和无功能障碍性 LBP 患者之间除性别、体重、C 反应蛋白（CRP）水平和生物制剂使用者的患病率外，许多变量存在显著差异。多因素 logistic 回归分析显示，体质指数（BMI；比值比 [OR]，1.116；P<0.001）、RA 发病年龄（OR，1.020；P=0.020）、RA 病程（OR，1.043；P<0.001）、甲氨蝶呤（MTX）使用（OR，0.609；P=0.007）、椎体骨折（OR，2.189；P=0.001）、椎体终板和/或小关节侵蚀（OR，1.411；P=0.043）、28 关节 C 反应蛋白疾病活动评分（DAS28-CRP）（OR，1.587；P=0.001）、骨盆倾斜（PT；OR，1.023；P=0.019）和矢状垂直轴（SVA；OR，1.007；P=0.043）是相关因素。
RA 患者功能障碍性 LBP 的相关因素是更多的椎体骨折、更高的 DAS28-CRP、椎体终板和/或小关节侵蚀、更高的 BMI、更长的病程、更大的 PT、发病年龄更大、更大的 SVA 和更少的 MTX 使用。严格控制患者的体重和疾病活动度，使用 MTX，通过预防脊柱骨盆失稳来避免脊柱骨盆失稳是很重要的。这些幻灯片可以在电子补充材料中检索到。
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