Influence of systemic bone mineral density on atlantoaxial subluxation in patients with rheumatoid arthritis

Han, Myung Hoon; Ryu, Je Il; Kim, C. H.; Kim, J. M.; Cheong, Jin Hwan; Bak, Koang Hum; Chun, Hyoung Joon

doi:10.1007/s00198-017-3972-9

Cited by 12 publications

(10 citation statements)

References 32 publications

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“…Demineralization was found on radiographs in almost half of the patients. Han et al suggested that patients with low bone mineral density (BMD) and lower body mass index (BMI) have a higher risk of AAS [ 27 ]. Rossini et al suggested that osteoporosis may be an independent risk factor for bone erosions in RA [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Radiological Evaluation of Cervical Spine Involvement in Rheumatoid Arthritis: A Cross-Sectional Retrospective Study

Kotecki

Gasik

Głuszko

et al. 2021

JCM

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Background: Cervical spine lesions are a common manifestation of rheumatoid arthritis (RA). The purpose of this study was to conduct a retrospective analysis of radiological lesions in cervical spine in patients with RA and to correlate findings with clinical and laboratory parameters. Methods: Overall, 240 consecutive patients with RA were referred for imaging by clinicians based on symptoms suggesting cervical spine involvement and/or long disease duration. In each patient, lateral radiographs and MRI of the cervical spine were performed. The imaging data were correlated with clinical records and laboratory data. Results: The cervical spine was affected in 179 patients (75%). The most common lesions were anterior atlanto-axial subluxation (AAS; 58%), subaxial subluxation (58%), and demineralization (48%). Cervical spine involvement was linked to longer disease duration (p = 0.007), the presence of rheumatoid factor (RF; p = 0.010), elevated C-reactive protein (CRP) levels (p = 0.016), and accelerated erythrocyte sedimentation rate (ESR; p = 0.025). Longer disease duration was associated with anterior AAS (p = 0.005), subaxial subluxation (p = 0.005), and basilar settling (p = 0.003). Conclusions: As many as 75% of RA patients develop lesions that can be observed on radiographs and through MRI. The most frequent radiological findings include anterior AAS and subaxial subluxation. Long disease duration, RF seropositivity, and elevated inflammatory markers were risk factors for cervical spine involvement.

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Section: Discussionmentioning

confidence: 99%

Radiological Evaluation of Cervical Spine Involvement in Rheumatoid Arthritis: A Cross-Sectional Retrospective Study

Kotecki

Gasik

Głuszko

et al. 2021

JCM

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“…Osteoporotic conditions may lead to atlantoaxial ligament laxity. These conditions may be aggravated in RA patients with a lower BMI [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

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

Uchino

Higashi

Kobayashi

et al. 2021

BMC Musculoskelet Disord

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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.

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“…Hence, we noted that half of patients with AAS had more frequent extra articular features. To our knowledge, few data in the literature are available regarding the association between cervical spine involvement and osteoporosis during RA (Han et al., 2017; Neva et al., 2006; Uchino et al., 2021). We found that 66% of patients with AAS had osteoporosis ( p = 0.012).…”

Section: Discussionmentioning

confidence: 99%

Predictors factors of atlanto‐axial subluxation in Tunisian patients with rheumatoid arthritis

Bettaieb

Ferjani

Nessib

et al. 2023

Musculoskeletal Care

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BackgroundThe aim of this study was to describe clinical and imaging features of atlantoaxial subluxation (AAS) and the associated risk factors in patients with rheumatoid arthritis (RA).MethodsWe conducted a retrospective and comparative study including 51 RA patients with AAS and 51 RA patients without AAS. Atlantoaxial subluxation was defined by the presence of an anterior C1C2 diastasis on the cervical spine radiograph in hyperflexion and/or an anterior, posterior, lateral or rotatory C1C2 dislocation on MRI with/without inflammatory signal.ResultsIn G1, clinical presentations revealing AAS were mainly neck pain (68.7%) and neck stiffness (29.8%). MRI revealed: diastasis C1C2 (92.5%), periodontoid pannus (92.5%), odontoid erosion (23.5%), vertical subluxation (9.8%) and spinal cord involvement (7.8%). A collar immobilisation and corticosteroid boluses were indicated in 86.3% and 47.1% of cases. C1‐C2arthrodesis was performed in 15.4% of cases. Atlantoaxial subluxation was significantly associated with: age at disease onset (p = 0.009), history of joint surgery (p = 0.012), disease duration (p = 0.001), rheumatoid factor (p = 0.01), anti‐cyclic citrullinated peptide (p = 0.02), erosive radiographic status (p < 0.005), coxitis (p < 0.001), osteoporosis (p = 0.012), extra‐articular manifestations (p < 0.001), and high disease activity (p = 0.001). Multivariate analysis identified RA duration (p < 0.001, OR = 1.022 CI[1.01–1.034]) and erosive radiographic status (p = 0.01, OR = 21.236 CI[2.05–219.44]) as predictive factors of AAS.ConclusionOur study showed that longer disease duration and joint destruction are the major predictive factors of AAS. Early treatment initiation, tight‐control and regular monitoring of cervical spine involvement are required in these patients.

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Influence of systemic bone mineral density on atlantoaxial subluxation in patients with rheumatoid arthritis

Abstract: Our study showed a possible association between lower BMD and AAS occurrence in patients with RA with lower BMI. Further studies are needed to confirm our findings.

Cited by 12 publications

References 32 publications

Radiological Evaluation of Cervical Spine Involvement in Rheumatoid Arthritis: A Cross-Sectional Retrospective Study

Radiological Evaluation of Cervical Spine Involvement in Rheumatoid Arthritis: A Cross-Sectional Retrospective Study

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

Predictors factors of atlanto‐axial subluxation in Tunisian patients with rheumatoid arthritis

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