类风湿关节炎初治患者颈椎失稳情况及临床特征

doi:10.19723/j.issn.1671-167X.2021.06.007

摘要/Abstract

摘要：

目的:研究初治类风湿关节炎(rheumatoid arthritis, RA)患者合并颈椎失稳者占比情况以及临床特征,并与经治RA患者颈椎失稳的发生情况及临床特点进行比较。方法:纳入2015年8月至2019年10月北京大学深圳医院和北京大学第三医院风湿免疫科住院期间行颈椎X线检查且有临床用药记录的RA患者,收集包括颈部症状等临床表现和实验室资料以及颈椎影像学资料进行分析。统计初治RA患者颈椎失稳人群的构成比,比较有无颈椎失稳两组初治RA患者的临床资料,比较初治及经治RA患者的颈椎失稳情况和临床特点。结果:408例RA患者中初治患者105例,女性87例,占82.9%,患者平均年龄(52±14)岁,病程中位数24个月,最短2周,最长30年。28.6%(30/105)合并颈椎失稳,其中病程≤24个月的初治RA颈椎失稳的发生率达13.6%。颈椎失稳组和无颈椎失稳组患者的颈部相关症状差异无统计学意义,与未合并颈椎失稳患者相比,颈椎失稳患者病程更长[60(18,180)个月vs. 16(8,51)个月],更多合并外周关节畸形(63.3%vs. 21.3%),血红蛋白水平较低 [(106.90±21.61) g/L vs. (115.77±14.69) g/L],经治及初治RA患者颈椎失稳构成比差异无统计学意义。合并颈椎失稳RA患者中,初治RA患者除病程更短[120.0 (72.0, 240.0)个月vs. 60.0 (27.0, 167.5)个月]外,各类型构成情况与经治RA患者差异无统计学意义。结论:初治RA患者颈椎失稳发生率较高,与经治RA患者颈椎失稳发生率相似,病程小于24个月的早期初治RA患者中已有相当比例合并颈椎失稳;颈部相关症状在初治RA患者合并颈椎失稳人群中并无明显特异性;对具有病程长、外周关节畸形比例高及血红蛋白水平低临床特点的初治RA患者应注意排查颈椎失稳。

关键词: 类风湿关节炎, 颈椎失稳, 外周关节畸形, 颈部症状

Abstract:

Objective: To study the proportion of cervical spine instability in treatment-naive rheumatoid arthritis (RA) patients, to investigate the associated neck symptoms, and to analyze the clinical characteristics in treatment-naive RA patients and treated RA patients. Methods: RA patients who underwent cervical spine X-ray imaging from the Department of Rheumatology and Immunology of Peking University Third Hospital and Peking University Shenzhen Hospital from August 2015 to October 2019 and had clinical records of medication administration were included. Clinical and laboratory data including cervical symptoms and X-ray imaging data of cervical spine were collected. The constituent ratio of cervical spine instability in treatment-naive RA patients was statistically analyzed. The clinical data and laboratory data were analyzed by t-test, u-test and chi square to explore the clinical characteristics of the treatment-naive RA patients with cervical instability. Results: Of the 408 RA patients, 105 patients were treatment-naive. Of the 105 treatment-naive patients, 82.9% (87/105) were female, with an average age of (52±14) years, the median duration of the disease was 24 months, the shortest history was 2 weeks, and the longest history was 30 years. 28.6% (30/105) of the treatment-naive RA patients showed cervical spine instability. The prevalence of cervical instability was 13.6% in the treatment-naive RA patients with disease duration less than 24 months. Among them, there were no significant differences in neck symptoms between cervical spine instability group and none cervical spine instability group. The patients with cervical spine instability had a longer duration of disease [60 (18,180) months vs.16 (8,51) months], a higher proportion of peripheral joint deformity (63.3%vs.21.3%), and a lower hemoglobin [(106.90±21.61) g/L vs. (115.77±14.69) g/L]. There was no significant difference in the occurrence of cervical instability in the treatment-naive RA patients compared with treated RA patients. Among the RA patients with cervical instability, there was no statistically significant difference in the composition of each type between the patients with treatment-naive RA and patients with treated RA, except for a shorter duration of disease [120.0 (72.0, 240.0) months vs. 60.0 (27.0, 167.5) months]. Conclusion: 28.6% of treatment-naive RA patients showed cervical spine instability. Cervical instability was also common in RA patients with a duration less than 24 months. There was no significant correlation between cervical instability and neck symptoms. Patients with cervical spine instability had a long-term disease, a higher proportion of peripheral joint deformity and a lower hemoglobin. Controlling the condition of RA early may help to control the progression of cervical involvement in patients with RA.

Key words: Rheumatoid arthritis, Cervical spine instability, Peripheral joint deformity, Neck symptom

中图分类号:

R593.22

张璐,胡小红,陈澄,蔡月明,王庆文,赵金霞. 类风湿关节炎初治患者颈椎失稳情况及临床特征[J]. 北京大学学报（医学版）, 2021, 53(6): 1049-1054.

ZHANG Lu,HU Xiao-hong,CHEN Cheng,CAI Yue-ming,WANG Qing-wen,ZHAO Jin-xia. Analysis of cervical instability and clinical characteristics in treatment-naive rheumatoid arthritis patients[J]. Journal of Peking University (Health Sciences), 2021, 53(6): 1049-1054.

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参考文献 18

[1]	Yang SY, Boniello AJ, Poorman CE, et al. A review of the diagnosis and treatment of atlantoaxial dislocations[J]. Global Spine, 2014, 4(3):197-210.
[2]	Olinger CR, Bransford R. Upper cervical trauma[J]. Orthop Clin North Am, 2021, 52(4):451-479. doi: 10.1016/j.ocl.2021.05.013
[3]	Hedequist D, Bekelis K, Emans J, et al. Single stage reduction and stabilization of basilar invagination after failed prior fusion surgery in children with Down’s syndrome[J]. Spine (Phila Pa 1976), 2010, 35(4):E128-133. doi: 10.1097/BRS.0b013e3181bad0c2
[4]	张璐, 刘湘源. 不可忽视类风湿关节炎的颈椎受累[J]. 中华风湿病学杂志, 2015, 19(4):217-218.
[5]	张璐, 胡小红, 王庆文, 等. 类风湿关节炎合并颈椎失稳的人群分布及临床特征[J]. 北京大学学报(医学版), 2020, 52(6):50-55.
[6]	Bodakçi E, Üsküdar CD, Ertürk A, et al. Can neck pain be an initial symptom of rheumatoid arthritis? A case report and literature review[J]. Rheumatol Int, 2018, 38(5):925-931. doi: 10.1007/s00296-018-4019-z pmid: 29589114
[7]	Baek IW, Joo YB, Park KS, et al. Risk factors for cervical spine instability in patients with rheumatoid arthritis[J]. Clin Rheumatol, 2021, 40(2):547-555. doi: 10.1007/s10067-020-05243-9
[8]	Mori Y, Izumiyama T, Baba K, et al. Evaluation of risk factors of vertebral fracture in Japanese female patients with glucocorticoid-induced osteoporosis[J]. J Orthop Surg Res, 2020, 15(1):290. doi: 10.1186/s13018-020-01813-4 pmid: 32727595
[9]	Sandström T, Rantalaiho V, Yli-Kerttula T, et al. Cervical spine involvement among patients with rheumatoid arthritis treated actively with treat-to-target strategy: 10-year results of the NEO-RACo study[J]. J Rheumatol, 2020. 47(8):1160-1164. doi: 10.3899/jrheum.190139 pmid: 31732558
[10]	Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative[J]. Ann Rheum Dis, 2010, 69(9):1580-1588. doi: 10.1136/ard.2010.138461 pmid: 20699241
[11]	Joaquim AF, Ghizoni E, Tedeschi H, et al. Radiological evaluation of cervical spine involvement in rheumatoid arthritis[J]. Neurosurg Focus, 2015, 38(4):E4.
[12]	Shlobin NA, Dahdaleh NS. Cervical spine manifestations of rheumatoid arthritis: A review[J]. Neurosurg Rev, 2021, 44(4):1957-1965. doi: 10.1007/s10143-020-01412-1
[13]	Drosos AA, Pelechas E, Voulgari PV. Radiological findings of the cervical spine in rheumatoid arthritis: What a rheumatologist should know[J]. Curr Rheumatol Rep, 2020, 22(6):19. doi: 10.1007/s11926-020-00894-8
[14]	Zhang T, Pope J. Cervical spine involvement in rheumatoid arthritis over time: Results from a meta-analysis[J]. Arthritis Res Ther, 2015, 17(1):148. doi: 10.1186/s13075-015-0643-0
[15]	Mańczak M, Gasik R. Cervical spine instability in the course of rheumatoid arthritis-imaging methods[J]. Reumatologia, 2017, 55(4):201-207.
[16]	Zhu S, Xu W, Luo Y, et al. Cervical spine involvement risk factors in rheumatoid arthritis: A meta-analysis[J]. Int J Rheum Dis, 2017, 20(5):541-549. doi: 10.1111/apl.2017.20.issue-5
[17]	Na MK, Chun HJ, Bak KH, et al. Risk factors for the development and progression of atlantoaxial subluxation in surgically treated rheumatoid arthritis patients, considering the time interval between rheumatoid arthritis diagnosis and surgery[J]. J Korean Neurosurg Soc, 2016, 59(6):590-596. doi: 10.3340/jkns.2016.59.6.590
[18]	Möller B, Everts-graber J, Florentinus S, et al. Low hemoglobin and radiographic damage progression in early rheumatoid arthritis: secondary analysis from a phase Ⅲ trial[J]. Arthritis Care Res (Hoboken), 2018, 70(6):861-868. doi: 10.1002/acr.v70.6

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Items	Cervical spine instability group(n=30)	None cervical spine instability group(n=75)	P
Female, n(%)	28 (93.3)	59 (78.7)	0.072
Age/years, $\overline{x}$±s	50.57±14.41	52.73±13.43	0.466
Course of disease/months, M (P₂₅, P₇₅)	60 (18,180)	16 (8,51)	0.002
Swollen joints, M (P₂₅, P₇₅)	2 (1,7)	2 (2,7)	0.408
Tender joints, M (P₂₅, P₇₅)	5 (3,11)	4 (1,9)	0.241
Peripheral joint malformations, n(%)	19 (63.3)	16 (21.3)	<0.001
VAS measuring general health score, $\overline{x}$±s	5.12±2.20	4.26±2.29	0.083
DAS28-ESR score, $\overline{x}$±s	4.81±1.32	4.53±1.56	0.407
Anti-CCP positive, n(%)	27 (93.1)	60 (80.0)	0.105
RF positive, n(%)	27 (93.1)	62 (83.8)	0.214
High CRP levels, n(%)	15 (51.7)	44 (62.0)	0.344
ESR/(mm/h), M (P₂₅, P₇₅)	28.0 (12.5,64.0)	29.5 (20.0, 53.5)	0.468
WBC/(×10⁹/L), $\overline{x}$±s	6.05±2.04	6.58±2.02	0.228
HGB/(g/L), $\overline{x}$±s	106.90±21.62	115.77±14.69	0.045
PLT/(×10⁹/L), $\overline{x}$±s	292.13±120.96	288.96±88.38	0.882

Items	Treated(n=97)	Initial treatment(n=30)	P
Female, n(%)	76 (78.4)	28 (93.3)	0.112
Age (years), M (P₂₅, P₇₅)	57.0 (46.0, 64.0)	53.0 (38.5, 58.0)	0.178
Course of disease/months, M (P₂₅, P₇₅)	120.0 (72.0, 240.0)	60.0 (27.0, 167.5)	0.019
Neck symptoms, n(%)	33 (34.4)	16 (55.2)	0.073
DAS28-ESR score, $\overline{x}$±s	4.9±1.8	4.8±1.3	0.831
Swollen joints, M (P₂₅, P₇₅)	3.0 (0.0, 9.0)	2.5 (1.0, 7.5)	0.828
Tender joints, M (P₂₅, P₇₅)	5.0 (1.0, 15.0)	5.5 (3.0, 11.5)	0.778
Peripheral joint malformations, n(%)	57 (58.8)	19 (63.3)	0.816
VAS measuring general health score, $\overline{x}$±s	4.8±2.6	5.1±2.2	0.517
Anti-CCP positive, n(%)	81 (91)	27 (93.1)	0.999
ESR/(mm/h), M (P₂₅, P₇₅)	38.0 (18.0, 61.0)	28.0 (13.0, 60.0)	0.289
High CRP levels, n(%)	66 (71.0)	15 (51.7)	0.091
RF positive, n(%)	72 (77.4)	27 (93.1)	0.107
WBC/(×10⁹/L), $\overline{x}$±s	6.5±2.5	6.1±2.0	0.392
Hgb/(g/L), $\overline{x}$±s	111.4±17.8	106.9±21.6	0.250
PLT/(×10⁹/L), $\overline{x}$±s	285.7±108.1	292.1±121.0	0.783