Lebouille-Veldman Anna B, Huizinga Tom W J, Mekary Rania A, Vleggeert-Lankamp Carmen L A
Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, MA, USA.
Clin Rheumatol. 2025 May;44(5):1919-1926. doi: 10.1007/s10067-025-07408-w. Epub 2025 Apr 4.
RA patients are often prescribed glucocorticoids, although it is known that their long-term use increases the risk of osteoporosis and fractures. The association between glucocorticoid use and RA-associated cervical spine deformity is yet to be determined.
Duration and dose of glucocorticoid use were evaluated in patients with new onset RA (BeSt Trial). Missing values on the exposure were imputed using the last observation carried forward. Lateral X-rays at 5- and 10-year follow-ups were assessed for atlantoaxial subluxation (AAS) and subaxial subluxation (SAS). To estimate the association between glucocorticoids and cervical spine deformity, multiple logistic regression models adjusted for age, gender, baseline Disease Activity Score (DAS), ACPA positivity, and RF positivity were used to estimate odds ratios (ORs) and their 95% confidence intervals (CIs). Mediation analysis was performed to evaluate whether such potential association was mediated via mean DAS.
Cervical deformity (AAS and/or SAS > 2 mm) was observed in 108 (40%) out of 272 patients. For a 1-year increase in total duration of glucocorticoid use, the adjusted OR for RA-associated cervical spine deformity was 1.19 (95% CI, 1.03-1.38; p = 0.02), and for an increase of 1 g of glucocorticoid in total cumulative dose, the OR was 1.06 (95% CI, 1.01-1.12; p = 0.02). Mediation analysis could not reveal an influence of mean DAS on these associations.
There was evidence of a direct association between long-term use of glucocorticoids in newly diagnosed RA patients and RA-associated cervical spine deformity after 10 years. Other effective therapies to suppress disease activity may be preferred over glucocorticoids. Key Points • For a 1-year increase in total duration of prednisone use in RA patients, the adjusted OR for RA-associated cervical spine deformity was 1.17 (95% CI, 1.01-1.36; p = 0.04). • For an increase in total cumulative dose of 1 g of prednisone in RA patients, the adjusted OR for RA-associated cervical spine deformity was 1.06 (95% CI, 1.00-1.11; p = 0.04). • The use of glucocorticoids in RA patients was associated with an increased odds of RA-associated cervical spine deformity after 10 years, which may suggest that other effective therapies to suppress disease activity should be preferred over glucocorticoids.
类风湿关节炎（RA）患者常被处方使用糖皮质激素，尽管已知长期使用会增加骨质疏松和骨折的风险。糖皮质激素的使用与RA相关的颈椎畸形之间的关联尚未确定。
在新发RA患者（BeSt试验）中评估糖皮质激素的使用持续时间和剂量。使用末次观察值结转法填补暴露因素的缺失值。在5年和10年随访时的颈椎侧位X线片评估寰枢椎半脱位（AAS）和下颈椎半脱位（SAS）。为了估计糖皮质激素与颈椎畸形之间的关联，使用针对年龄、性别、基线疾病活动评分（DAS）、抗环瓜氨酸肽（ACPA）阳性和类风湿因子（RF）阳性进行校正的多因素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这种潜在关联是否通过平均DAS介导。
272例患者中有108例（40%）出现颈椎畸形（AAS和/或SAS＞2mm）。糖皮质激素总使用持续时间每增加1年，RA相关颈椎畸形的校正OR为1.19（95%CI，1.03 - 1.38；P = 0.02），糖皮质激素总累积剂量每增加1g，OR为1.06（95%CI，1.01 - 1.12；P = 0.02）。中介分析未发现平均DAS对这些关联有影响。
有证据表明，新诊断的RA患者长期使用糖皮质激素与10年后RA相关的颈椎畸形存在直接关联。抑制疾病活动的其他有效疗法可能比糖皮质激素更可取。要点 • RA患者泼尼松总使用持续时间每增加1年，RA相关颈椎畸形的校正OR为1.17（95%CI，1.01 - 1.36；P = 0.04）。 • RA患者泼尼松总累积剂量增加1g，RA相关颈椎畸形的校正OR为1.06（95%CI，1.00 - 1.11；P = 0.04）。 • RA患者使用糖皮质激素与10年后RA相关颈椎畸形的几率增加有关，这可能表明抑制疾病活动的其他有效疗法应比糖皮质激素更可取。
