Lebouille-Veldman Anna B, Spenkelink Dylan, Huizinga Tom W J, Vleggeert-Lankamp Carmen L A
Department of Neurosurgery, Leiden University Medical Centre, Leiden, the Netherlands.
Biomedical Engineering, University of Twente, the Netherlands.
Brain Spine. 2025 Mar 14;5:104235. doi: 10.1016/j.bas.2025.104235. eCollection 2025.
While rheumatoid arthritis (RA)-associated cervical spine deformity seems to be less prevalent following the introduction of the medication regimen to suppress inflammation in RA in an early stage, identifying patients at risk for atlantoaxial subluxation (AAS) or subaxial subluxation (SAS) remains challenging.
The aim of the current study is to evaluate the association of the frequency of flares in systemic disease activity (DAS) and RA-associated cervical spine deformity.
This is a sub-analysis of the BeSt Study, where patients were treated to target DAS≤2.4. Lateral X-rays at 5- and 10-years follow-up were assessed for AAS and SAS.
Of 272 RA patients with radiographs of cervical spine that were included, 108 (40 %) had cervical deformity (AAS and/or SAS >2 mm). Although the number of patients with 3 or more flares was low, the majority of these patients did not demonstrate cervical spine deformity. After adjustment for the potential confounders age, gender, ACPA-status and RF-status, the presence of 3 or more flares was associated with a non-significant OR of 0.338 (95 % CI: 0.095-1.207) for the presence of RA-associated cervical spine deformity after 10 years.
A trend towards less RA-associated cervical deformity in patients with more flares was discerned, though no statistically significant differences could be established. It is hypothesized that the occurrence of a flare leads to an increase in medication, which may in turn protect the cervical spine from developing deformities. Future studies should more in detail explore the effect of medication on cervical deformity.
虽然在早期引入抑制类风湿关节炎（RA）炎症的药物治疗方案后，RA相关的颈椎畸形似乎不太常见，但识别有寰枢椎半脱位（AAS）或下颈椎半脱位（SAS）风险的患者仍然具有挑战性。
本研究的目的是评估全身疾病活动度（DAS）发作频率与RA相关颈椎畸形之间的关联。
这是对BeSt研究的一项亚分析，该研究中患者接受治疗以使DAS≤2.4。在5年和10年随访时评估颈椎侧位X线片以检测AAS和SAS。
纳入的272例有颈椎X线片的RA患者中，108例（40%）有颈椎畸形（AAS和/或SAS>2mm）。虽然发作3次或更多次的患者数量较少，但这些患者中的大多数并未表现出颈椎畸形。在对年龄、性别、抗环瓜氨酸肽（ACPA）状态和类风湿因子（RF）状态等潜在混杂因素进行调整后，发作3次或更多次与10年后存在RA相关颈椎畸形的非显著比值比0.338（95%CI：0.095 - 1.207）相关。
虽然未发现统计学上的显著差异，但在发作次数较多的患者中观察到RA相关颈椎畸形有减少的趋势。据推测，发作的发生会导致药物使用增加，这可能反过来保护颈椎不发生畸形。未来的研究应更详细地探讨药物对颈椎畸形的影响。
