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Lebouille-Veldman AB, Spenkelink D, Allaart CF, Vleggeert-Lankamp CLA. The association between Disease Activity Score and rheumatoid arthritis-associated cervical deformity: radiological evaluation of the BeSt trial. J Neurosurg Spine 2023; 38:465-472. [PMID: 36640102 DOI: 10.3171/2022.12.spine221057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/07/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The authors' objective was to evaluate the association of the Disease Activity Score (DAS) with cervical spine deformity in rheumatoid arthritis (RA) patients during 10-year optimal treatment of systemic disease. METHODS The authors evaluated radiological and 10-year follow-up (FU) data of the BeSt (BehandelStrategien) trial. In 272 RA patients, atlantoaxial subluxation (AAS), presence of vertical translocation (VT), and subaxial subluxation (SAS) were evaluated. The associations of these deformities with DAS, self-assessed health (determined with the Health Assessment Questionnaire [HAQ]), and erosions of the hands and feet (Sharp-Van der Heijde score) were studied. RESULTS After 10 years of FU, AAS (> 2 mm neutral position) was observed in 62 patients (23%), AAS (≥ 3 mm in flexion) in 24%, AAS (≥ 5 mm in flexion) in 7%, VT did not occur, and SAS was present in 60 patients (22%). In total, 135 patients (50%) were in remission (DAS < 1.6) at 10 years of FU. No association could be established between AAS and DAS. Patients with cervical spine deformity (AAS > 2 mm and/or SAS) at 10 years had a higher HAQ score at 10 years than patients without cervical spine deformity (HAQ scores of 0.65 and 0.51, respectively, p = 0.04; 95% CI -0.29 to 0.00). CONCLUSIONS Even though 50% of patients were in remission after 10 years and the BeSt trial was designed to optimize treatment, 40% of patients developed at least mild RA-associated cervical spine deformity and 7% developed significant AAS. This indicates that even in this era of disease-modifying antirheumatic drugs and biologicals, cervical deformity is prevalent among patients with RA and should not be neglected in patient treatment plans and information.
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Affiliation(s)
| | | | - Cornelia F Allaart
- 2Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Carmen L A Vleggeert-Lankamp
- Departments of1Neurosurgery and.,4Department of Neurosurgery, The Hague Medical Centre and HAGA Teaching Hospital, The Hague, The Netherlands; and.,5Department of Neurosurgery, Spaarne Hospital Haarlem/Hoofddorp, The Netherlands
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2
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Chu ECP, Wong AYL, Lee LYK. Craniocervical instability associated with rheumatoid arthritis: a case report and brief review. AME Case Rep 2021; 5:12. [PMID: 33912801 DOI: 10.21037/acr-20-131] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/05/2020] [Indexed: 11/06/2022]
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease that affects the synovial tissue which lines joints and tendons. The craniocervical junction is made up exclusively of synovial joints and ligaments and especially vulnerable to the inflammatory process of RA. The chronic inflammation of RA leads to loss of ligamentous restriction and erosion of the bony structures and results in craniocervical instability (CCI). This is a case report of an 80-year-old woman who had been diagnosed with seropositive RA two decades ago presented with head dropping and losing balance while walking for several months. Radiographic images of the cervical spine showed RA-related features of instability in the form of atlantoaxial instability, cranial settling and subaxial subluxation. Since physical therapy and acupuncture previously failed to provide a substantial, long-lasting outcome, the patient sought chiropractic care for her condition. The chiropractic regimen consisted of upper thoracic spine mobilization/adjustment, electrical muscle stimulation of the cervical extensors, home exercises and neck bracing. She regained substantial neck muscle strength, gaze angle and walking balance following a 4-month chiropractic treatment, although cervical kyphosis persisted. The current study aims to provide basic knowledge of CCI associated with RA and ability to modify a treatment program to accommodate the needs of patients with coexisting red flags.
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Affiliation(s)
- Eric Chun-Pu Chu
- New York Chiropractic & Physiotherapy Centre, New York Medical Group, Hong Kong, China
| | - Arnold Yu-Lok Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Linda Yin-King Lee
- School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong, China
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Smartphone Application with Virtual Reality Goggles for the Reliable and Valid Measurement of Active Craniocervical Range of Motion. Diagnostics (Basel) 2019; 9:diagnostics9030071. [PMID: 31295869 PMCID: PMC6787724 DOI: 10.3390/diagnostics9030071] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 06/28/2019] [Accepted: 07/09/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: This study aimed to determine the intra-rater and inter-rater reliability and validity of a hybrid device, combining virtual reality goggles, a magnetometer and an inclinometer application for smartphones, to measure craniocervical range. Summary of Background Data: Accurate evaluation of craniocervical range of motion is important for early detection of certain diseased conditions and monitoring the progress of interventions. The universal goniometer is widely used for the measurement but it requires experienced practitioners. Whether a combination of virtual reality goggles and smartphone applications can provide the same or better performance compared with the goniometer is still unknown. Methods: Forty-one healthy adults from the department of physical medicine and rehabilitation were recruited for craniocervical range examination (flexion, extension, side-bending to the right or left and rotating to the right or left) by using the hybrid device and universal goniometer. Using the hybrid device, repeated measurements were performed twice by a primary rater and once by a second rater. The primary rater also conducted a measurement using the universal goniometer in the same cohort. The intra-rater and inter-rater reliability (intra-class correlation coefficient (ICC)) were calculated using the two-way random effect model, whereas the validity was examined by the Pearson correlation coefficient and Bland-and-Altman plot. The interval between the first and second sessions of the measurement for intra-rater reliability was set at 30 min. Results: Excellent intra-rater (ICC ≥ 0.925) and inter-rater (ICC ≥ 0.880) reliability was noted for the hybrid device. The minimal detectable changes from intra-observer and inter-observer comparisons ranged between 4.12° and 7.42° in all six directions. The Bland-and-Altman plot revealed small mean differences (≤1.68°) between the hybrid device and universal goniometer. Both instruments had highly correlated measurements of craniocervical motion (r values ≥ 0.918). Conclusion: For healthy participants, excellent intra-rater and inter-rater reliability was noted for the hybrid device, and the measurements were consistent with the universal goniometer measurements. Future studies are needed to examine whether the device can perform similarly for patients with neck disorders.
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Abozaid HSM, El-din Hassan RA, Elmadany WA, Ismail MA, Elgendy DS, Elsayed SA, Gamal RM, Daifallah OS, Abu Alfadl EM. Is It the Age at Disease Onset or the Disease Radiological Severity That Affects Cervical Spine Involvement in Patients With Rheumatoid Arthritis? CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544118759688. [PMID: 35140540 PMCID: PMC8819744 DOI: 10.1177/1179544118759688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/25/2018] [Indexed: 11/25/2022]
Abstract
Background: Cervical spine involvement in patients with rheumatoid arthritis (RA) can
cause pain and disability, with a variety of neurologic signs and
symptoms. Objectives: To investigate the relationship between structural cervical spine involvement
in patients with RA with the age at disease onset and the degree of
radiologic severity of RA measured by Larsen scoring. Patients and methods: This cross-sectional study included 50 adult patients with RA. Patients who
complained or not complained from symptoms of cervical spine involvement in
RA were included; we did X-ray of the cervical spine, hands, and feet;
Larsen scoring method; disease activity score (DAS28); and Neck Disability
Index. Results: The results revealed that patients with cervical involvement tend to be
younger at their disease onset than those with no cervical involvement, as
detected by cervical X-ray. The relation was significant
P < .05 regarding all cervical involvements except for
basilar invagination. Disease radiological severity (measured by Larsen
score) significantly increases the risk for subaxial subluxation,
P = .040. All other cervical complications of RA tend
to have nonsignificant relation with disease severity. Using univariate
binary regression analysis for risk factors for cervical involvement showed
that the only probable risk factor for cervical involvement (detected by
X-ray) in patients with RA is age at disease onset. Conclusions: The early age at disease onset tends to affect cervical spine involvement in
patients with RA more than the disease radiological severity.
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Affiliation(s)
- Hanan Sayed M Abozaid
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
| | - Reham Alaa El-din Hassan
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
| | - Waleed A Elmadany
- Diagnostic Radiology Department, Faculty of Medicine, Sohag University Hospital, Sohag, Egypt
| | - Mohamed Aly Ismail
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
| | - Dalia S Elgendy
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
| | - Sahar A Elsayed
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
| | - Rania M Gamal
- Rheumatology and Rehabilitation Department, Assuit University Hospital, Assuit, Egypt
| | - Osama S Daifallah
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
| | - Esam M Abu Alfadl
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
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Cañas CA, Tobón GJ, Bonilla-Abadía F. The importance of evolution in the development and course of rheumatoid arthritis. Med Hypotheses 2014; 82:784-91. [PMID: 24746382 DOI: 10.1016/j.mehy.2014.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/24/2014] [Indexed: 12/29/2022]
Abstract
Rheumatoid arthritis (RA) is a complex autoimmune disease of recent evolutionary origin. Genetic drift determines diverse polymorphisms implicated in the susceptibility to RA including the major histocompatibility complex (MHC) class II genes in the so-called shared epitope. These genes originated after the divergence between Homo and Pan from their common ancestry Ardipithecus ramidus about 5 million years ago. Natural selection determined the particular changes in the legs (bipedal position), hands, neck, brain and eusociality in humans which influence the clinical presentation of RA. In this article, we hypothesized that the origin and course of RA may be explainable in the light of evolution.
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Affiliation(s)
- C A Cañas
- Rheumatology Unit, Fundación Valle del Lili, Universidad ICESI, Cali, Colombia
| | - G J Tobón
- Rheumatology Unit, Fundación Valle del Lili, Universidad ICESI, Cali, Colombia.
| | - F Bonilla-Abadía
- Rheumatology Unit, Fundación Valle del Lili, Universidad ICESI, Cali, Colombia; Human Molecular Genetics Laboratory, Universidad del Valle, Cali, Colombia
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Elhai M, Wipff J, Bazeli R, Freire V, Feydy A, Drape JL, Quartier P, Kahan A, Job-Deslandre C. Radiological cervical spine involvement in young adults with polyarticular juvenile idiopathic arthritis. Rheumatology (Oxford) 2012; 52:267-75. [DOI: 10.1093/rheumatology/kes054] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Assessment of cervical pain and function in patients with rheumatoid arthritis. Clin Rheumatol 2011; 30:831-6. [DOI: 10.1007/s10067-011-1687-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 12/14/2010] [Accepted: 01/07/2011] [Indexed: 12/11/2022]
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SUPPIAH RAVI, DOYLE ANTHONY, RAI RAYLYNNE, DALBETH NICOLA, LOBO MARIA, BRAUN JÜRGEN, McQUEEN FIONAM. Quantifying Bone Marrow Edema in the Rheumatoid Cervical Spine Using Magnetic Resonance Imaging. J Rheumatol 2010; 37:1626-32. [DOI: 10.3899/jrheum.091299] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To determine the reliability and feasibility of a new magnetic resonance imaging (MRI) score to quantify bone marrow edema (BME), synovitis, and erosions in the cervical spine of patients with rheumatoid arthritis (RA); and to investigate the correlations among neck pain, clinical markers of RA disease activity, and MRI features of disease activity in the cervical spine.Methods.Thirty patients with RA (50% with neck pain) and a Disease Activity Score 28-joint count > 3.2 had an MRI scan of their cervical spine. STIR, VIBE, and T1-weighted postcontrast sequences were used to quantify BME. MRI scans were scored for total BME, synovitis, and erosions using a new scoring method developed by the authors and assessed for reliability and feasibility. Associations between neck pain and clinical markers of disease activity were investigated.Results.BME was present in 14/30 patients; 9/14 (64%) had atlantoaxial BME, 10/14 (71%) had subaxial BME, and 5/14 (36%) had both. Interobserver reliability for total cervical BME score was moderate [intraclass correlation coefficient (ICC) = 0.51]. ICC improved to 0.67 if only the vertebral bodies and dens were considered. There was no correlation between neck pain or clinical measures of RA disease activity and the presence of any MRI features including BME, synovitis, or erosions.Conclusion.Current RA disease activity scores do not identify activity in the cervical spine. An MRI score that quantifies BME, synovitis, and erosions in the cervical spine may provide useful information regarding inflammation and damage. This could alert clinicians to the presence of significant pathology and influence management.
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KAUPPI MARKKUJ, NEVA MARKOH, LAIHO KARI, KAUTIAINEN HANNU, LUUKKAINEN REIJO, KARJALAINEN ANNA, HANNONEN PEKKAJ, LEIRISALO-REPO MARJATTA, KORPELA MARKKU, ILVA KIRSTI, MÖTTÖNEN TIMO. Rheumatoid Atlantoaxial Subluxation Can Be Prevented by Intensive Use of Traditional Disease Modifying Antirheumatic Drugs. J Rheumatol 2009; 36:273-8. [DOI: 10.3899/jrheum.080429] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.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.Methods.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).Results.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 and Disease Activity Score 28 values were found in patients who developed aAAS during the 5-year followup.Conclusion.RA patients with sustained clinical disease activity and poor HAQ are at increased risk of developing aAAS. The development of aAAS during the first 5 years of RA was rare among the patients treated with a combination of DMARD for at least 2 years from the diagnosis. Intensive treatment with traditional DMARD prevents or retards the development of aAAS in patients with recentonset RA.
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Abstract
This article defines specific risks associated with rheumatoid arthritis, including an increased incidence of medical comorbidities, the use of steroids and other immunosuppressive agents, osteoporosis, vascular disease, and the common occurrence of severe deformity. This article suggests approaches for management and techniques that may improve specific surgical issues in this challenging patient population.
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Affiliation(s)
- Vincent James Sammarco
- Cincinnati Sports Medicine and Orthopaedic Center, 10663 Montgomery Road, Cincinnati, OH 45242, USA.
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Hong SJ, Lee JB, Jung SW, Kim IS, Lim SY, Shin KM. Atlantoaxial Joint Syndrome Misconceived as an Idiopathic Neuralgia -A case report-. Korean J Pain 2005. [DOI: 10.3344/kjp.2005.18.1.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Seong Joon Hong
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Seoul, Korea
| | - Jeong Beom Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Seoul, Korea
| | - Seung Won Jung
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Seoul, Korea
| | - Il Seok Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Seoul, Korea
| | - So Young Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Seoul, Korea
| | - Keun Man Shin
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Seoul, Korea
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