Geraldo-Flores N A, Merlos-López R J, Rodríguez-Wong J A, Ramírez-Hernández S, Espino-Lizarraga M J, Pérez-Atanasio J M
Hospital Regional 2. Instituto Mexicano del Seguro Social (IMSS) Villa Coapa. Ciudad de México, México.
Servicio de Columna, Hospital Regional 2. Instituto Mexicano del Seguro Social (IMSS) Villa Coapa. Ciudad de México, México.
Acta Ortop Mex. 2018 Nov-Dec;32(6):342-346.
Cervical spine involvement is common in patients with RA, risk factors such as disease activity may be related to asymptomatic cervical instability.
To determine the associated factors for asymptomatic cervical spine instability in patients with rheumatoid arthritis.
Case and control study from the external spine and rheumatology consultation of a level II trauma center to identify all patients diagnosed with rheumatoid arthritis (RA) and asymptomatic cervical instability. With simple X-rays of the cervical spine, carrying out radiographic measurements, the diagnosis of cervical instability was performed, risk factors such as the presence of rheumatoid factor (FR), previous articular surgeries, elevations of the C-reactive protein (PCR) values were evaluated. The severity and activity of the disease measured in the activity index of 28 articulations (DAS 28) in addition to the index of activity of the simplified disease (SDAI).
We assessed 32 patients, nine patients (28.1%) met the criteria for instability of the anterior cervical spine atlantoaxial subluxation (SAAa) (100%), also one patient with SAAa presented vertical subluxation (SV), risk factors more relevant: DAS 28 with an OR = 3.54, SDA with an OR = 2.34 and finally the PCR 1.0 its OR = 2.88.
The risk factors associated opportunely in our population are the severity of the activity of the disease that we can see in the DAS and SDAI when applied in patients and PCR 1.0.
类风湿关节炎（RA）患者颈椎受累很常见，疾病活动等危险因素可能与无症状颈椎不稳有关。
确定类风湿关节炎患者无症状颈椎不稳的相关因素。
对一家二级创伤中心的脊柱外科和风湿病会诊进行病例对照研究，以识别所有诊断为类风湿关节炎（RA）且有无症状颈椎不稳的患者。通过颈椎简单X线片进行影像学测量，以诊断颈椎不稳，评估类风湿因子（RF）的存在、既往关节手术、C反应蛋白（CRP）值升高等危险因素。除简化疾病活动指数（SDAI）外，还采用28个关节活动指数（DAS28）来衡量疾病的严重程度和活动度。
我们评估了32例患者，9例患者（28.1%）符合颈椎前路寰枢椎半脱位（SAAa）不稳标准（100%），还有1例SAAa患者出现垂直半脱位（SV），更相关的危险因素：DAS28的比值比（OR）=3.54，SDAI的OR=2.34，最后CRP≥1.0时其OR=2.88。
在我们的研究人群中，适时相关的危险因素是应用于患者时在DAS和SDAI中可见的疾病活动严重程度以及CRP≥1.0。
