Factors That Predict Risk of Cervical Instability in Rheumatoid Arthritis Patients

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Abstract

Study Design. Retrospective data analysis. Objective. To identify factors affecting the atlantodental interval, the Ranawat value, and subaxial translation after rheumatoid arthritis (RA) diagnosis. In addition, factors predictive for cervical spine instability (CSI) development after RA diagnosis were examined. Summary of Background Data. Development of CSI affects the prognosis and mortality of RA patients. Previous studies described that obesity is associated with reduced radiographic joint damage in RA patients. We hypothesized that body mass index (BMI) is also associated with radiographic cervical damage in RA patients. Methods. Cervical radiographs were taken at full flexion, neutral position, and full extension to measure the geometric length of the anterior atlantodental interval, the Ranawat value, and subaxial translation. These values were entered into multivariable linear regression analysis based on potential associated factors. Hazard ratios were calculated to identify independent factors predictive of CSI. Results. Of the patients diagnosed with RA between January 2005 and August 2015, 1611 who underwent at least one cervical radiograph were included. After adjusting for sex, age, BMI category, CSI, rheumatoid factor, and RA medication, multivariate analysis revealed that the risk of atlantoaxial subluxation in the underweight and normal BMI groups was about 1.6-fold (hazard ratio, 1.63; 95% CI, 1.10-2.43; P = 0.015) and 1.7-fold higher, respectively, than that in the obese group, and that the risk of vertical subluxation was about 2.5-fold (hazard ratio, 2.52; 95% CI, 1.32-4.83; P = 0.005) higher in the underweight group than in the obese group. We also found that the rheumatoid factor positivity was a predictive risk factor for CSI development. Conclusion. We identified risk factors predictive for CSI occurrence after RA diagnosis through cervical radiograph assessment. We found that BMI was an independent predictor for development of CSI. Further large-scale prospective studies are required to confirm these findings.

Original languageEnglish
Pages (from-to)966-973
Number of pages8
JournalSpine
Volume42
Issue number13
DOIs
StatePublished - 2017 Jul 1

Fingerprint

Rheumatoid Arthritis
Spine
Body Mass Index
Thinness
Rheumatoid Factor
Linear Models
Multivariate Analysis
Obesity
Joints
Regression Analysis
Prospective Studies
Mortality

Keywords

  • atlantoaxial subluxation
  • atlantodental interval
  • body mass index
  • cervical spine instability
  • Ranawat value
  • rheumatoid arthritis
  • rheumatoid factor
  • subaxial subluxation
  • subaxial translation
  • vertical subluxation

Cite this

@article{a288aa7482fc4f219158f857c5a6c27e,
title = "Factors That Predict Risk of Cervical Instability in Rheumatoid Arthritis Patients",
abstract = "Study Design. Retrospective data analysis. Objective. To identify factors affecting the atlantodental interval, the Ranawat value, and subaxial translation after rheumatoid arthritis (RA) diagnosis. In addition, factors predictive for cervical spine instability (CSI) development after RA diagnosis were examined. Summary of Background Data. Development of CSI affects the prognosis and mortality of RA patients. Previous studies described that obesity is associated with reduced radiographic joint damage in RA patients. We hypothesized that body mass index (BMI) is also associated with radiographic cervical damage in RA patients. Methods. Cervical radiographs were taken at full flexion, neutral position, and full extension to measure the geometric length of the anterior atlantodental interval, the Ranawat value, and subaxial translation. These values were entered into multivariable linear regression analysis based on potential associated factors. Hazard ratios were calculated to identify independent factors predictive of CSI. Results. Of the patients diagnosed with RA between January 2005 and August 2015, 1611 who underwent at least one cervical radiograph were included. After adjusting for sex, age, BMI category, CSI, rheumatoid factor, and RA medication, multivariate analysis revealed that the risk of atlantoaxial subluxation in the underweight and normal BMI groups was about 1.6-fold (hazard ratio, 1.63; 95{\%} CI, 1.10-2.43; P = 0.015) and 1.7-fold higher, respectively, than that in the obese group, and that the risk of vertical subluxation was about 2.5-fold (hazard ratio, 2.52; 95{\%} CI, 1.32-4.83; P = 0.005) higher in the underweight group than in the obese group. We also found that the rheumatoid factor positivity was a predictive risk factor for CSI development. Conclusion. We identified risk factors predictive for CSI occurrence after RA diagnosis through cervical radiograph assessment. We found that BMI was an independent predictor for development of CSI. Further large-scale prospective studies are required to confirm these findings.",
keywords = "atlantoaxial subluxation, atlantodental interval, body mass index, cervical spine instability, Ranawat value, rheumatoid arthritis, rheumatoid factor, subaxial subluxation, subaxial translation, vertical subluxation",
author = "Myung-Hoon Han and Ryu, {Je Il} and Kim, {Choong Hyun} and Kim, {Jae Min} and Jin-Hwan Cheong and Bak, {Koang Hum} and Hyoung-Joon Chun and Hyeong-Joong Yi and Jae-Bum Jun and Chung, {Jae Woo}",
year = "2017",
month = "7",
day = "1",
doi = "10.1097/BRS.0000000000001942",
language = "English",
volume = "42",
pages = "966--973",
journal = "Spine",
issn = "0362-2436",
number = "13",

}

TY - JOUR

T1 - Factors That Predict Risk of Cervical Instability in Rheumatoid Arthritis Patients

AU - Han, Myung-Hoon

AU - Ryu, Je Il

AU - Kim, Choong Hyun

AU - Kim, Jae Min

AU - Cheong, Jin-Hwan

AU - Bak, Koang Hum

AU - Chun, Hyoung-Joon

AU - Yi, Hyeong-Joong

AU - Jun, Jae-Bum

AU - Chung, Jae Woo

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Study Design. Retrospective data analysis. Objective. To identify factors affecting the atlantodental interval, the Ranawat value, and subaxial translation after rheumatoid arthritis (RA) diagnosis. In addition, factors predictive for cervical spine instability (CSI) development after RA diagnosis were examined. Summary of Background Data. Development of CSI affects the prognosis and mortality of RA patients. Previous studies described that obesity is associated with reduced radiographic joint damage in RA patients. We hypothesized that body mass index (BMI) is also associated with radiographic cervical damage in RA patients. Methods. Cervical radiographs were taken at full flexion, neutral position, and full extension to measure the geometric length of the anterior atlantodental interval, the Ranawat value, and subaxial translation. These values were entered into multivariable linear regression analysis based on potential associated factors. Hazard ratios were calculated to identify independent factors predictive of CSI. Results. Of the patients diagnosed with RA between January 2005 and August 2015, 1611 who underwent at least one cervical radiograph were included. After adjusting for sex, age, BMI category, CSI, rheumatoid factor, and RA medication, multivariate analysis revealed that the risk of atlantoaxial subluxation in the underweight and normal BMI groups was about 1.6-fold (hazard ratio, 1.63; 95% CI, 1.10-2.43; P = 0.015) and 1.7-fold higher, respectively, than that in the obese group, and that the risk of vertical subluxation was about 2.5-fold (hazard ratio, 2.52; 95% CI, 1.32-4.83; P = 0.005) higher in the underweight group than in the obese group. We also found that the rheumatoid factor positivity was a predictive risk factor for CSI development. Conclusion. We identified risk factors predictive for CSI occurrence after RA diagnosis through cervical radiograph assessment. We found that BMI was an independent predictor for development of CSI. Further large-scale prospective studies are required to confirm these findings.

AB - Study Design. Retrospective data analysis. Objective. To identify factors affecting the atlantodental interval, the Ranawat value, and subaxial translation after rheumatoid arthritis (RA) diagnosis. In addition, factors predictive for cervical spine instability (CSI) development after RA diagnosis were examined. Summary of Background Data. Development of CSI affects the prognosis and mortality of RA patients. Previous studies described that obesity is associated with reduced radiographic joint damage in RA patients. We hypothesized that body mass index (BMI) is also associated with radiographic cervical damage in RA patients. Methods. Cervical radiographs were taken at full flexion, neutral position, and full extension to measure the geometric length of the anterior atlantodental interval, the Ranawat value, and subaxial translation. These values were entered into multivariable linear regression analysis based on potential associated factors. Hazard ratios were calculated to identify independent factors predictive of CSI. Results. Of the patients diagnosed with RA between January 2005 and August 2015, 1611 who underwent at least one cervical radiograph were included. After adjusting for sex, age, BMI category, CSI, rheumatoid factor, and RA medication, multivariate analysis revealed that the risk of atlantoaxial subluxation in the underweight and normal BMI groups was about 1.6-fold (hazard ratio, 1.63; 95% CI, 1.10-2.43; P = 0.015) and 1.7-fold higher, respectively, than that in the obese group, and that the risk of vertical subluxation was about 2.5-fold (hazard ratio, 2.52; 95% CI, 1.32-4.83; P = 0.005) higher in the underweight group than in the obese group. We also found that the rheumatoid factor positivity was a predictive risk factor for CSI development. Conclusion. We identified risk factors predictive for CSI occurrence after RA diagnosis through cervical radiograph assessment. We found that BMI was an independent predictor for development of CSI. Further large-scale prospective studies are required to confirm these findings.

KW - atlantoaxial subluxation

KW - atlantodental interval

KW - body mass index

KW - cervical spine instability

KW - Ranawat value

KW - rheumatoid arthritis

KW - rheumatoid factor

KW - subaxial subluxation

KW - subaxial translation

KW - vertical subluxation

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U2 - 10.1097/BRS.0000000000001942

DO - 10.1097/BRS.0000000000001942

M3 - Article

C2 - 27792120

AN - SCOPUS:84992754182

VL - 42

SP - 966

EP - 973

JO - Spine

JF - Spine

SN - 0362-2436

IS - 13

ER -