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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (6): 1049-1054. doi: 10.19723/j.issn.1671-167X.2021.06.007

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Analysis of cervical instability and clinical characteristics in treatment-naive rheumatoid arthritis patients

ZHANG Lu1,HU Xiao-hong2,CHEN Cheng1,CAI Yue-ming1,WANG Qing-wen1,ZHAO Jin-xia3,△()   

  1. 1. Department of Rheumatology & Immunology, Shenzhen 518036, Guangdong, China
    2. Department of medical imaging, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
    3. Department of Rheumatology & Immunology, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-06-24 Online:2021-12-18 Published:2021-12-13
  • Contact: Jin-xia ZHAO E-mail:zhao-jinxia@163.com

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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

CLC Number: 

  • R593.22

Figure 1

Cervical dynamic X-ray in RA patients with combined anterior atlantoaxial subluxation A, extend excessive position; B, neutral position; C, bend excessive position. AADI, anterioratlanto-odontoidinterval."

Table 1

Comparison of clinical characteristics of initial treatment RA patients with cervical spine instability and none cervical spine instability"

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

Table 2

Comparison of clinical characteristics of initial treatment RA patients and treated RA patients in RA patients with cervical spine instability"

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
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