Lebouille-Veldman Anna Baukje, Huizinga Tom W J, Mekary Rania A, Vleggeert-Lankamp Carmen L A
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.
RMD Open. 2025 Mar 18;11(1):e005237. doi: 10.1136/rmdopen-2024-005237.
Over the past decades, the incidence of surgery for rheumatoid arthritis (RA)-associated cervical spine deformity decreased. Infliximab has been observed as a protective treatment for joint damage in hands and feet; yet, the protective association between infliximab and the cervical spine has been uncertain.
Duration of infliximab use during 10 years of follow-up was evaluated in patients with new-onset RA (case control study using data from the BeSt Trial). Missing values on the exposure were imputed using last observation carried forward. Lateral X-rays at 5-year and 10-year follow-ups were assessed for atlantoaxial subluxation (AAS) and subaxial subluxation (SAS). Multiple logistic regression models adjusted for age, gender, baseline Disease Activity Score (DAS44), ACPA-positivity and rheumatoid factor-positivity were used to estimate ORs and their 95% CIs. Mediation analysis was performed to evaluate whether a potential association was mediated via mean DAS44.
Cervical deformity (AAS and/or SAS>2 mm) was observed in 108 (40%) of 272 patients. There was an 11% reduction in odds for cervical spine deformity (OR: 0.89, 95% CI: 0.81 to 0.98; p=0.02) for every 1-year increase in duration of infliximab use. Mediation analysis could not reveal an influence of DAS44 on the association between infliximab use and cervical spine outcomes.
There was evidence of a beneficial association between longer duration of use of infliximab and cervical spine deformity after 10 years follow-up. Thus, it is important to balance the favourable effects of infliximab use for the joints and possibly the cervical spine with the potential adverse events of this medication when used continuously.
Netherlands Trial Register Number: NTR262.
在过去几十年中，类风湿关节炎（RA）相关颈椎畸形的手术发生率有所下降。英夫利昔单抗已被视为一种预防手足关节损伤的治疗方法；然而，英夫利昔单抗与颈椎之间的保护关联尚不确定。
在新发病的RA患者中评估英夫利昔单抗在10年随访期间的使用时长（使用来自BeSt试验的数据进行病例对照研究）。暴露方面的缺失值采用末次观察值结转法进行插补。在5年和10年随访时评估颈椎侧位X线片，以判断寰枢椎半脱位（AAS）和下颈椎半脱位（SAS）情况。使用针对年龄、性别、基线疾病活动评分（DAS44）、抗环瓜氨酸肽抗体（ACPA）阳性和类风湿因子阳性进行校正的多重逻辑回归模型来估计比值比（OR）及其95%置信区间（CI）。进行中介分析以评估潜在关联是否通过平均DAS44介导。
272例患者中有108例（40%）出现颈椎畸形（AAS和/或SAS>2 mm）。英夫利昔单抗使用时长每增加1年，颈椎畸形的发生几率降低11%（OR：0.89，95% CI：0.81至0.98；p=0.02）。中介分析未发现DAS44对英夫利昔单抗使用与颈椎结局之间的关联有影响。
有证据表明，在10年随访后，英夫利昔单抗使用时长较长与颈椎畸形之间存在有益关联。因此，在持续使用这种药物时，平衡英夫利昔单抗对关节以及可能对颈椎的有利影响与该药物潜在的不良事件非常重要。
荷兰试验注册号：NTR262
