Risk Factors Associated With Cervical Spine Lesions in Patients With Rheumatoid Arthritis: The Role of Biological Agents

Abstract

Purpose To investigate the prevalence and risk factors of cervical lesions in patients with rheumatoid arthritis (RA) under current pharmacological treatments with biological agents. Methods One hundred and 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), vertical subluxation (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 of 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 younger age of onset, longer RA disease duration, and lower femoral neck BMD than those in the non-cervical-lesion group. Multivariate analyses showed that the risk factors of RA cervical lesions were RA disease duration, prednisolone usage, biological agents, and femoral neck BMD. Femoral neck BMD in patients with VS was lower than in those without VS. Conclusions Cervical lesions were confirmed in 57% of the patients. RA duration, prednisolone usage, biological agents, and femoral neck BMD were significant risk factors of cervical lesions in patients with RA. The general status of osteoporosis might contribute to the development of VS.