Rheumatoid atlantoaxial subluxation can be prevented by intensive use of traditional disease modifying antirheumatic drugs

The Journal of Rheumatology
Markku KauppiFIN-RACo Trial Group

Abstract

To evaluate the 5-year incidence of cervical spine disorders in patients with early rheumatoid arthritis (RA) treated by 2 different disease modifying antirheumatic drug (DMARD) strategies. In a national, multicenter, prospective FIN-RACo-trial, a cohort of 199 patients with early, clinically active RA was randomly assigned to treatment with a combination of 3 DMARD and prednisolone (Combi group) or with a single DMARD (Single group) with or without prednisolone, aiming to induce remission. After 2 years, the DMARD therapy was unrestricted. Lateral view cervical spine radiographs during full flexion and extension were taken at the 5-year followup visits. The presence of anterior atlantoaxial subluxation (aAAS), atlantoaxial impaction (AAI), and subaxial subluxation (SAS) was assessed in the 149 patients with radiographs available (80 Single and 69 Combi). At the 5-year visits, aAAS, AAI, and SAS were found in 13 (9%), 6 (4%), and 9 (6%) patients, respectively. The corresponding Single/Combi group ratios were 11/2, 5/1, and 5/4. Of the baseline data, only poor physical function [Health Assessment Questionnaire (HAQ); p = 0.024] and Single treatment strategy (p = 0.019) were significantly associated with aAAS. Worse HAQ scores an...Continue Reading

References

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Citations

Dec 10, 2013·Best Practice & Research. Clinical Rheumatology·Marjatta Leirisalo-Repo
Mar 27, 2013·Nature Reviews. Rheumatology·Thomas D Cha, Howard S An
Aug 26, 2014·Autoimmunity Reviews·Andrei F Joaquim, Simone Appenzeller
Sep 22, 2015·Expert Review of Clinical Immunology·Walter GrassiEmilio Filippucci
Aug 10, 2011·Physical Medicine and Rehabilitation Clinics of North America·Elana M ObersteinAviva Hopkins
Jan 15, 2013·Scandinavian Journal of Rheumatology·M BlomP L C M van Riel
Feb 11, 2015·Current Rheumatology Reports·Han Jo KimRichard Brasington
Dec 3, 2010·Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders·Howaida E MansourMoataz M S Elbeblawy
Jun 17, 2010·The Journal of Rheumatology·Ravi SuppiahFiona M McQueen
May 15, 2013·Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases·Susan M Goodman
Oct 22, 2015·Current Neurology and Neuroscience Reports·Alicia M ZhaRéza Behrouz
Jun 4, 2020·Continuum : Lifelong Learning in Neurology·Pantelis P Pavlakis
Mar 29, 2018·Rheumatology International·Erdal BodakçiCengiz Korkmaz

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