Predictive Risk Factors of Cervical Spine Instabilities in Rheumatoid Arthritis

Spine ◽  
2017 ◽  
Vol 42 (8) ◽  
pp. 556-564 ◽  
Author(s):  
Yoshiki Terashima ◽  
Takashi Yurube ◽  
Hiroaki Hirata ◽  
Daisuke Sugiyama ◽  
Masatoshi Sumi
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cervical Spine ◽  
Predictive Risk

scholarly journals Risk Factor Analysis of Perioperative Complications in Patients with Rheumatoid Arthritis Undergoing Primary Cervical Spine Surgery

2021 ◽  
Author(s):  
Koji Sakuraba ◽  
Yuki Omori ◽  
Kazuhiro Kai ◽  
Kazumasa Terada ◽  
Nobuo Kobara ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Factor Analysis ◽  
Risk Factor ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Perioperative Complications ◽  
High Dose ◽  
Cervical Spine Surgery ◽  
Lower Height

Abstract Background: Rheumatoid arthritis (RA) often causes cervical spine lesions as the disease condition progresses, which induce occipital neuralgia or cervical myelopathy requiring surgical interventions. Meanwhile, patients with RA are susceptible to infection or other complications in the perioperative period because they frequently have comorbidities and use immunosuppressive medications. However, the risk factors or characteristics of patients with RA who experience perioperative complications after cervical spine surgery remain unknown. A risk factor analysis of perioperative complications in patients with RA who underwent primary cervical spine surgery was conducted in the present study.Methods: A total of 139 patients with RA who underwent primary cervical spine surgery from January 2001 to March 2020 were retrospectively investigated. Age and height, weight, serum albumin, serum C-reactive protein, American Society of Anesthesiologists Physical Status (ASA-PS), Charlson comorbidity index, medications used, cervical spine lesion, surgery time, bleeding volume, and procedures were collected from medical records to compare the patients with complications to those without complications after surgery. The risk factors for perioperative complications were assessed by univariate and multivariate logistic regression analysis.Results: Twenty-eight patients (20.1%) had perioperative complications. Perioperative complications were significantly associated with the following factors [data presented as odds ratio (confidence interval)]: lower height [0.928 (0.880-0.980), p=0.007], higher ASA-PS [2.296 (1.007-5.235), p=0.048], longer operation time [1.013 (1.004-1.021), p=0.003], more bleeding volume [1.004 (1.000-1.007), p=0.04], higher rates of vertical subluxation [2.914 (1.229-6.911), p=0.015] and subaxial subluxation (SAS) [2.507 (1.063-5.913), p=0.036], occipito-cervical (OC) fusion [3.438 (1.189-9.934), p=0.023], and occipito-cervical/thoracic (long) fusion [8.021 (2.145-29.99), p=0.002] in univariate analyses. In multivariate analyses, lower height [0.915 (0.860-0.974), p=0.005], higher ASA-PS [2.622 (1.023-6.717), p=0.045] and long fusion [7.289 (1.694-31.36), p=0.008] remained risk factors. High-dose prednisolone use [1.247 (1.024-1.519), p=0.028], SAS [6.413 (1.381-29.79), p=0.018], OC fusion [17.93 (1.242-258.8), p=0.034] and long fusion [108.1 (6.876-1699), p<0.001] were associated with severe complications.Conclusions: ASA-PS and long fusion could be indicators predicting perioperative complications in patients with RA after cervical spine surgery. In addition, cervical spine lesions requiring OC fusion or long fusion and high-dose prednisolone use were suggested to be risk factors for increasing severe complications.

Cervical spine involvement risk factors in rheumatoid arthritis: a meta-analysis

2017 ◽  
Vol 20 (5) ◽  
pp. 541-549 ◽  
Author(s):  
Shuai Zhu ◽  
Wangdong Xu ◽  
Yubin Luo ◽  
Yi Zhao ◽  
Yi Liu
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cervical Spine ◽  
Meta Analysis

scholarly journals Risk factors associated with cervical spine lesions in patients with rheumatoid arthritis: an observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yosuke Uchino ◽  
Takayuki Higashi ◽  
Naomi Kobayashi ◽  
Tetsuhiko Inoue ◽  
Yuichi Mochida ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cervical Spine ◽  
Femoral Neck ◽  
Cervical Lesion ◽  
Biological Agent ◽  
Lesion Group ◽  
Upper Cervical Spine ◽  
Cervical Lesions ◽  
Mineral Density

Abstract Background Few reports have described the association between rheumatoid arthritis (RA) cervical lesions and osteoporosis, especially in patients with vertical subluxation (VS) that could be induced by the collapse of lateral masses in the upper cervical spine. Therefore, this study aimed to investigate the prevalence and risk factors for cervical lesions in patients with RA under current pharmacological treatments with biological agents, and to investigate the relationship between osteoporosis and VS development. Methods One hundred eighty-five consecutive patients with RA who underwent both cervical plain radiography and bone mineral density (BMD) scanning were enrolled. RA cervical lesions included atlantoaxial subluxation (AAS), VS, and subaxial subluxation (SAS). We assigned patients with AAS, VS, or SAS to the cervical-lesion group, and all other patients to the non-cervical-lesion group. Radiological findings, BMD, and clinical data on RA were collected. We used multivariate logistic regression analyses to assess the risk factors for cervical lesions in patients with RA. Results The cervical-lesion and non-cervical-lesion groups included 106 and 79 patients, respectively. There were 79 patients with AAS, 31 with VS, and 41 with SAS. The cervical-lesion group had a younger age of RA onset, longer RA disease duration, higher RA stage, and lower femoral neck BMD than the non-cervical-lesion group. Multivariate analyses showed that the risk factors for RA cervical lesions were prednisolone usage, biological agent usage, and higher RA stage. Prednisolone usage and femoral neck BMD were the risk factors for VS. Conclusions Cervical lesions were confirmed in 57 % of the patients. Prednisolone usage, biological agent usage, and higher RA stage were significant risk factors for cervical lesions in patients with RA. The general status of osteoporosis might contribute to the development of VS.

Predictive risk factors of serious infections in patients with rheumatoid arthritis treated with abatacept in common practice: results from the Orencia and Rheumatoid Arthritis (ORA) registry

2015 ◽  
Vol 75 (6) ◽  
pp. 1108-1113 ◽  
Author(s):  
J H Salmon ◽  
J E Gottenberg ◽  
P Ravaud ◽  
A Cantagrel ◽  
B Combe ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Univariate Analysis ◽  
Real Life ◽  
Recurrent Infections ◽  
Predicting Factors ◽  
Serious Infections ◽  
History Of ◽  
Predictive Risk

ObjectivesLittle data are available regarding the rate and predicting factors of serious infections in patients with rheumatoid arthritis (RA) treated with abatacept (ABA) in daily practice. We therefore addressed this issue using real-life data from the Orencia and Rheumatoid Arthritis (ORA) registry.MethodsORA is an independent 5-year prospective registry promoted by the French Society of Rheumatology that includes patients with RA treated with ABA. At baseline, 3 months, 6 months and every 6 months or at disease relapse, during 5 years, standardised information is prospectively collected by trained clinical nurses. A serious infection was defined as an infection occurring during treatment with ABA or during the 3 months following withdrawal of ABA without any initiation of a new biologic and requiring hospitalisation and/or intravenous antibiotics and/or resulting in death.ResultsBaseline characteristics and comorbidities: among the 976 patients included with a follow-up of at least 3 months (total follow-up of 1903 patient-years), 78 serious infections occurred in 69 patients (4.1/100 patient-years). Predicting factors of serious infections: on univariate analysis, an older age, history of previous serious or recurrent infections, diabetes and a lower number of previous anti-tumour necrosis factor were associated with a higher risk of serious infections. On multivariate analysis, only age (HR per 10-year increase 1.44, 95% CI 1.17 to 1.76, p=0.001) and history of previous serious or recurrent infections (HR 1.94, 95% CI 1.18 to 3.20, p=0.009) were significantly associated with a higher risk of serious infections.ConclusionsIn common practice, patients treated with ABA had more comorbidities than in clinical trials and serious infections were slightly more frequently observed. In the ORA registry, predictive risk factors of serious infections include age and history of serious infections.

Risk Factors Associated with Aggravation of Cervical Spine Lesions in Patients with Rheumatoid Arthritis

Spine ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Tetsuhiko Inoue ◽  
Takayuki Higashi ◽  
Naomi Kobayashi ◽  
Manabu Ide ◽  
Kengo Harigane ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cervical Spine ◽  
Factors Associated

scholarly journals AB0187 PREVALENCE, RISK FACTORS, AND TREATMENT MODALITIES OF ATLANTOAXIAL DISLOCATION IN RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1118.1-1118
Author(s):  
K. Maatallah ◽  
S. Miri ◽  
H. Ferjani ◽  
D. Ben Nsib ◽  
W. Triki ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cervical Spine ◽  
Disease Activity ◽  
Joint Damage ◽  
Treatment Modalities ◽  
Cross Sectional ◽  
Significant Difference ◽  
Structural Joint ◽  
The Mean

Background:Cervical spine involvement is common in patients with rheumatoid arthritis (RA). The most common abnormality is atlantoaxial dislocation (AAD). It may lead to severe neurological symptoms and even death. Currently, there is a lack of consensus on the best approach to treatment.Objectives:We investigated the prevalence of and risk factors for AAD in patients with RA, as well as its relationship to treatment modalities.Methods:We conducted a cross-sectional study including 224 patients with RA. All patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria. Radiographs of the cervical spine included lateral views taken in flexion, extension, neutral position of the neck, anteroposterior and odontoid projection view. Patients were divided into two groups: (G1) a group with AAD and (G2) without ADD. We compared clinical, radiological, and laboratory findings between the two groups, as well as the treatments used: Steroid therapy, classic and biologic disease-modifying anti-rheumatic drugs (DMARDs). Structural joint damage was assessed with the Sharp/van der Heijde radiographic method. Functional impairment was assessed using the Health Assessment Questionnaire (HAQ). We used Statistical Package for Social Sciences (SPSS) 22.0 to analyze the results. The level of statistical significance was set at 0.05.Results:ADD was present in 16% of the cases (n=36). Female predominance was noted, with a sex ratio of 0.25 (p=0.530). The mean age was 58±12 years, with no significant difference between groups (p=0.146). The mean disease duration was significantly higher in G1 (11.5 ± 10.5 years versus 5.9 ± 6.3, p=0.004). A noticeable relationship between AAD and immunopositivity was found: rheumatoid factor (RF) was present in 86.1% of the cases in G1 versus 67.5% in G2 (p=0.025). Anti-citrullinated protein antibodies (ACPA) were present in 86.1% of the cases in G1 versus 64.8% in G2 (p=0.012). We found a significant difference between AAD and disease activity assessed by DAS28-VS (5.8±1.3 in G1 versus 5.3±1.6 in G2,p=0.027). AAD was significantly associated with more structural joint damage: erosions (121.1±60.9 in G1 versus 61.8±56.5 in G2,p<10-3), joints space narrowing (77.4±47.4 in G1 versus 38.7±40 in G2, p<10-3), Sharp/van der Heijde radiographic score (190.2±103.1 in G1 versus 100.1±90.6 in G2, p<10-3). Hip involvement was more frequent in G1 (22.2% versus 9.4% in G2, p=0.038).HAQ score was higher in G1 (1.8±0.7 versus 1.2±1, p=0.002).Seventy-five percent of patients in G1 had received methotrexate versus 82.3% in G2 (p=0.301). The mean duration of methotrexate therapy was longer in G1 (24.6±23.5 versus18±24 months, p=0.015). G1 patients received a higher mean dose and cumulative dose of methotrexate: 13.2±3.5 g/week versus 11.8±4.4 g/week (p=0.048), and 6.5±6.8 versus 4.8±8.5 (p=0.025), respectively.Thirty-five percent of patients in G1 had received corticosteroids versus 25% in G2 (p=0.217). Patients in G1 had a significantly longer duration of steroid therapy: 17.8 + 20.2 versus 13.3 + 24.3 months (p=0.22). The mean dose of corticosteroids was similar between the two groups: 6.9±4.3 mg/day versus 5.7±4.6 mg/day (p=0.132). The total cumulative dose was significantly higher in G1: 6.5±6.8 mg/day versus 4.8±8.5 mg/day (p=0.025).There was no significant difference in using other DMARDs: Sulfasalazine (p=0.182) and leflunomide (p=0.276).No significant difference was observed with patients under biologic DMARDs: 24.1% in G1 versus 17% in G2 (p=0.725).Conclusion:Cervical spine involvement is common in RA and may be asymptomatic. Immunopositive patients seem to have more frequently ADD, as well as those with high disease activity and severe structural joint damage. The treatment modalities do not appear to be affected by AAD; however, patients with ADD seem to have higher cumulative doses of corticosteroids and methotrexate. Given the cross-sectional nature of our study, it is difficult to confirm the connection between the two. Further studies are needed.Disclosure of Interests:None declared

Functional MR imaging of the cervical spine in patients with rheumatoid arthritis

1998 ◽  
Vol 39 (5) ◽  
pp. 543-546 ◽  
Author(s):  
K. -H. Allmann ◽  
M. Uhl ◽  
P. Uhrmeister ◽  
K. Neumann ◽  
J. von Kempis ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Mr Imaging ◽  
Functional Mr Imaging

Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment

2020 ◽  
Vol 18 (5) ◽  
pp. 431-446 ◽  
Author(s):  
George E. Fragoulis ◽  
Ismini Panayotidis ◽  
Elena Nikiphorou
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Current Evidence ◽  
Pharmacological Intervention ◽  
Cvd Risk ◽  
The Past ◽  
Increased Risk ◽  
Cv Disease ◽  
Obesity Hypertension ◽  
Inflammatory Burden

Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.

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