RT Journal Article
SR Electronic
T1 Rheumatoid Atlantoaxial Subluxation Can Be Prevented by Intensive Use of Traditional Disease Modifying Antirheumatic Drugs
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 273
OP 278
DO 10.3899/jrheum.080429
VO 36
IS 2
A1 MARKKU J. KAUPPI
A1 MARKO H. NEVA
A1 KARI LAIHO
A1 HANNU KAUTIAINEN
A1 REIJO LUUKKAINEN
A1 ANNA KARJALAINEN
A1 PEKKA J. HANNONEN
A1 MARJATTA LEIRISALO-REPO
A1 MARKKU KORPELA
A1 KIRSTI ILVA
A1 TIMO MÖTTÖNEN
A1 for the FIN-RACo Trial Group
YR 2009
UL http://www.jrheum.org/content/36/2/273.abstract
AB 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.