Lebouille-Veldman Anna B, Spenkelink Dylan, Allaart Cornelia F, Vleggeert-Lankamp Carmen L A
Departments of1Neurosurgery and.
3Biomedical Engineering, University of Twente, The Netherlands.
J Neurosurg Spine. 2023 Jan 13;38(4):465-472. doi: 10.3171/2022.12.SPINE221057. Print 2023 Apr 1.
The authors' objective was to evaluate the association of the Disease Activity Score (DAS) with cervical spine deformity in rheumatoid arthritis (RA) patients during 10-year optimal treatment of systemic disease.
The authors evaluated radiological and 10-year follow-up (FU) data of the BeSt (BehandelStrategien) trial. In 272 RA patients, atlantoaxial subluxation (AAS), presence of vertical translocation (VT), and subaxial subluxation (SAS) were evaluated. The associations of these deformities with DAS, self-assessed health (determined with the Health Assessment Questionnaire [HAQ]), and erosions of the hands and feet (Sharp-Van der Heijde score) were studied.
After 10 years of FU, AAS (> 2 mm neutral position) was observed in 62 patients (23%), AAS (≥ 3 mm in flexion) in 24%, AAS (≥ 5 mm in flexion) in 7%, VT did not occur, and SAS was present in 60 patients (22%). In total, 135 patients (50%) were in remission (DAS < 1.6) at 10 years of FU. No association could be established between AAS and DAS. Patients with cervical spine deformity (AAS > 2 mm and/or SAS) at 10 years had a higher HAQ score at 10 years than patients without cervical spine deformity (HAQ scores of 0.65 and 0.51, respectively, p = 0.04; 95% CI -0.29 to 0.00).
Even though 50% of patients were in remission after 10 years and the BeSt trial was designed to optimize treatment, 40% of patients developed at least mild RA-associated cervical spine deformity and 7% developed significant AAS. This indicates that even in this era of disease-modifying antirheumatic drugs and biologicals, cervical deformity is prevalent among patients with RA and should not be neglected in patient treatment plans and information.
作者的目的是评估在类风湿关节炎（RA）患者系统性疾病的10年优化治疗期间，疾病活动评分（DAS）与颈椎畸形之间的关联。
作者评估了BeSt（治疗策略）试验的放射学和10年随访（FU）数据。对272例RA患者评估了寰枢椎半脱位（AAS）、垂直移位（VT）的存在情况以及下颈椎半脱位（SAS）。研究了这些畸形与DAS、自我评估健康状况（通过健康评估问卷[HAQ]确定）以及手足侵蚀（Sharp-Van der Heijde评分）之间的关联。
随访10年后，62例患者（23%）观察到AAS（中立位>2 mm），24%观察到AAS（屈曲位≥3 mm），7%观察到AAS（屈曲位≥5 mm），未发生VT，60例患者（22%）存在SAS。在随访10年时，共有135例患者（50%）处于缓解期（DAS<1.6）。AAS与DAS之间未发现关联。10年时存在颈椎畸形（AAS>2 mm和/或SAS）的患者在10年时的HAQ评分高于无颈椎畸形的患者（HAQ评分分别为0.65和0.51，p = 0.04；95%CI -0.29至0.00）。
尽管10年后50%的患者处于缓解期，且BeSt试验旨在优化治疗，但40%的患者出现了至少轻度的RA相关颈椎畸形，7%的患者出现了严重的AAS。这表明即使在这个使用改善病情抗风湿药物和生物制剂的时代，颈椎畸形在RA患者中仍然普遍存在，在患者治疗计划和信息提供中不应被忽视。
