Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Risk Factors for the Development and Progression of Atlantoaxial Subluxation in Surgically Treated Rheumatoid Arthritis Patients, Considering the Time Interval between Rheumatoid Arthritis Diagnosis and Surgery

  • Na, Min-Kyun (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Chun, Hyoung-Joon (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Bak, Koang-Hum (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Yi, Hyeong-Joong (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Ryu, Je Il (Department of Neurosurgery, Hanyang University Guri Hospital) ;
  • Han, Myung-Hoon (Department of Neurosurgery, Hanyang University Guri Hospital)
  • Received : 2016.05.30
  • Accepted : 2016.08.30
  • Published : 2016.11.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Rheumatoid arthritis (RA) is a systemic disease that can affect the cervical spine, especially the atlantoaxial region. The present study evaluated the risk factors for atlantoaxial subluxation (AAS) development and progression in patients who have undergone surgical treatment. Methods : We retrospectively analyzed the data of 62 patients with RA and surgically treated AAS between 2002 and 2015. Additionally, we identified 62 patients as controls using propensity score matching of sex and age among 12667 RA patients from a rheumatology registry between 2007 and 2015. We extracted patient data, including sex, age at diagnosis, age at surgery, disease duration, radiographic hand joint changes, and history of methotrexate use, and laboratory data, including presence of rheumatoid factor and the C-reactive protein (CRP) level. Results : The mean patient age at diagnosis was 38.0 years. The mean time interval between RA diagnosis and AAS surgery was $13.6{\pm}7.0$ years. The risk factors for surgically treated AAS development were the serum CRP level (p=0.005) and radiographic hand joint erosion (p=0.009). The risk factors for AAS progression were a short time interval between RA diagnosis and radiographic hand joint erosion (p<0.001) and young age at RA diagnosis (p=0.04). Conclusion : The CRP level at RA diagnosis and a short time interval between RA diagnosis and radiographic hand joint erosion might be risk factors for surgically treated AAS development in RA patients. Additionally, a short time interval between RA diagnosis and radiographic hand joint erosion and young age at RA diagnosis might be risk factors for AAS progression.

Keywords

References

  1. Ahn JK, Hwang JW, Oh JM, Lee J, Lee YS, Jeon CH : Risk factors for development and progression of atlantoaxial subluxation in Korean patients with rheumatoid arthritis. Rheumatol Int 31 : 1363-1368, 2011 https://doi.org/10.1007/s00296-010-1437-y
  2. Alamanos Y, Drosos AA : Epidemiology of adult rheumatoid arthritis. Autoimmun Rev 4 : 130-136, 2005 https://doi.org/10.1016/j.autrev.2004.09.002
  3. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. : The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31 : 315-324, 1988 https://doi.org/10.1002/art.1780310302
  4. Blom M, Creemers MC, Kievit W, Lemmens JA, van Riel PL : Longterm follow-up of the cervical spine with conventional radiographs in patients with rheumatoid arthritis. Scand J Rheumatol 42 : 281-288, 2013 https://doi.org/10.3109/03009742.2012.747625
  5. Casey AT, Crockard HA, Bland JM, Stevens J, Moskovich R, Ransford AO : Surgery on the rheumatoid cervical spine for the non-ambulant myelopathic patient-too much, too late? Lancet 347 : 1004-1007, 1996 https://doi.org/10.1016/S0140-6736(96)90146-4
  6. Delamarter RB, Bohlman HH : Postmortem osseous and neuropathologic analysis of the rheumatoid cervical spine. Spine (Phila Pa 1976) 19 : 2267-2274, 1994 https://doi.org/10.1097/00007632-199410150-00004
  7. Fujiwara K, Fujimoto M, Owaki H, Kono J, Nakase T, Yonenobu K, et al. : Cervical lesions related to the systemic progression in rheumatoid arthritis. Spine (Phila Pa 1976) 23 : 2052-2056, 1998 https://doi.org/10.1097/00007632-199810010-00003
  8. Hirano K, Imagama S, Oishi Y, Kanayama Y, Ito Z, Wakao N, et al. : Progression of cervical instabilities in patients with rheumatoid arthritis 5.7 years after their first lower limb arthroplasty. Mod Rheumatol 22 : 743-749, 2012 https://doi.org/10.3109/s10165-011-0584-7
  9. Ito H, Neo M, Sakamoto T, Fujibayashi S, Yoshitomi H, Nakamura T : Subaxial subluxation after atlantoaxial transarticular screw fixation in rheumatoid patients. Eur Spine J 18 : 869-876, 2009 https://doi.org/10.1007/s00586-009-0945-5
  10. Joaquim AF, Appenzeller S2 : Cervical spine involvement in rheumatoid arthritis--a systematic review. Autoimmun Rev 13 : 1195-1202, 2014 https://doi.org/10.1016/j.autrev.2014.08.014
  11. Kaito T, Hosono N, Ohshima S, Ohwaki H, Takenaka S, Fujiwara H, et al. : Effect of biological agents on cervical spine lesions in rheumatoid arthritis. Spine (Phila Pa 1976) 37 : 1742-1746, 2012 https://doi.org/10.1097/BRS.0b013e318256b584
  12. Konttinen YT, Bergroth V, Santavirta S, Sandelin J : Inflammatory involvement of cervical spine ligaments in patients with rheumatoid arthritis and atlantoaxial subluxation. J Rheumatol 14 : 531-534, 1987
  13. Mathews JA : Atlanto-axial subluxation in rheumatoid arthritis. A 5-year follow-up study. Ann Rheum Dis 33 : 526-531, 1974 https://doi.org/10.1136/ard.33.6.526
  14. Naranjo A, Carmona L, Gavrila D, Balsa A, Belmonte MA, Tena X, et al. : Prevalence and associated factors of anterior atlantoaxial luxation in a nation-wide sample of rheumatoid arthritis patients. Clin Exp Rheumatol 22 : 427-432, 2004
  15. Oda T, Fujiwara K, Yonenobu K, Azuma B, Ochi T : Natural course of cervical spine lesions in rheumatoid arthritis. Spine (Phila Pa 1976) 20 : 1128-1135, 1995 https://doi.org/10.1097/00007632-199505150-00004
  16. Ranawat CS, O'Leary P, Pellicci P, Tsairis P, Marchisello P, Dorr L : Cervical spine fusion in rheumatoid arthritis. J Bone Joint Surg Am 61 : 1003- 1010, 1979 https://doi.org/10.2106/00004623-197961070-00006
  17. Raskin RJ, Schnapf DJ, Wolf CR, Killian PJ, Lawless OJ : Computerized tomography in evaluation of atlantoaxial subluxation in rheumatoid arthritis. J Rheumatol 10 : 33-41, 1983
  18. Reiter MF, Boden SD : Inflammatory disorders of the cervical spine. Spine (Phila Pa 1976) 23 : 2755-2766, 1998 https://doi.org/10.1097/00007632-199812150-00017
  19. Renna R, Plantone F, Plantone D : Atlantoaxial subluxation in rheumatoid arthritis. J Rheumatol 40 : 1925, 2013 https://doi.org/10.3899/jrheum.130532
  20. Sharp J, Purser DW : Spontaneous atlanto-axial dislocation in ankylosing spondylitis and rheumatoid arthritis. Ann Rheum Dis 20 : 47-77, 1961 https://doi.org/10.1136/ard.20.1.47
  21. van Asselt KM, Lems WF, Bongartz EB, Hamburger HL, Drossaers- Bakker KW, Dijkmans BA, et al. : Outcome of cervical spine surgery in patients with rheumatoid arthritis. Ann Rheum Dis 60 : 448-452, 2001 https://doi.org/10.1136/ard.60.5.448
  22. van der Heijde DM, van't Hof MA, van Riel PL, van Leeuwen MA, van Rijswijk MH, van de Putte LB : Validity of single variables and composite indices for measuring disease activity in rheumatoid arthritis. Ann Rheum Dis 51 : 177-181, 1992 https://doi.org/10.1136/ard.51.2.177
  23. Winfield J, Cooke D, Brook AS, Corbett M : A prospective study of the radiological changes in the cervical spine in early rheumatoid disease. Ann Rheum Dis 40 : 109-114, 1981 https://doi.org/10.1136/ard.40.2.109
  24. Yurube T, Sumi M, Nishida K, Miyamoto H, Kohyama K, Matsubara T, et al. : Accelerated development of cervical spine instabilities in rheumatoid arthritis : a prospective minimum 5-year cohort study. PLoS One 9 : e88970, 2014 https://doi.org/10.1371/journal.pone.0088970
  25. Yurube T, Sumi M, Nishida K, Miyamoto H, Kohyama K, Matsubara T, et al. : Incidence and aggravation of cervical spine instabilities in rheumatoid arthritis : a prospective minimum 5-year follow-up study of patients initially without cervical involvement. Spine (Phila Pa 1976) 37 : 2136-2144, 2012 https://doi.org/10.1097/BRS.0b013e31826def1c
  26. Zhang T, Pope J : Cervical spine involvement in rheumatoid arthritis over time : results from a meta-analysis. Arthritis Res Ther 17 : 148, 2015 https://doi.org/10.1186/s13075-015-0643-0

Cited by

  1. Rheumatoide Arthritis der zervikalen Wirbelsäule : Diagnostik und Therapie rheumatisch bedingter Instabilitäten vol.77, pp.10, 2016, https://doi.org/10.1007/s00393-018-0564-9
  2. La severidad de la artritis reumatoide como predictor oportuno de inestabilidad de la columna cervical asintomática vol.32, pp.6, 2016, https://doi.org/10.35366/85431
  3. Retrospective analysis of surgical outcomes for atlantoaxial subluxation vol.14, pp.None, 2019, https://doi.org/10.1186/s13018-019-1112-2
  4. Impact of Chronic DMARD Therapy in Patients With Rheumatoid Arthritis Undergoing Surgery of the Craniovertebral Junction : A Multi-center Retrospective Study vol.45, pp.13, 2020, https://doi.org/10.1097/brs.0000000000003402