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活性类风湿性关节炎和脊椎病:一个中期队列研究

Shintaro Honda¹, Koichi Murata^1,2, Bungo Otsuki¹

¹Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, Japan.

|May 15, 2024

概括

类风湿性关节炎疾病活动和基线脊柱形严重程度预测了RA患者的进展. 较高的疾病活性,使用葡萄糖皮质激素和初始的科布角≥10°增加了脊椎病的进展风险.

科学领域:

类风湿病学类风湿病学
整形外科整形外科整形外科
脊柱外科手术脊柱外科手术

背景情况:

类风湿性关节炎 (RA) 经常与腰椎脊柱脊柱病同时发生,影响高达30%的患者.
关于RA患者脊椎病进展的纵向数据有限,这阻碍了对治疗疗效的理解.
现有的RA相关脊柱病治疗方法缺乏关于其预防曲线进展的能力的强有力的证据.

研究的目的:

在被诊断患有类风湿性关节炎的患者中确定影响脊椎病变进展的因素.
分析RA中疾病活性与脊柱形脊柱病进展率之间的关系.
通过使用纵向数据,确定RA患者脊椎病进展的风险因素.

主要方法:

一项回顾性队列研究涉及180名患有类风湿性关节炎的患者,随访时间超过2年.
根据疾病活动得分-28 (DAS28-ESR),患者被分为缓解和非缓解组.
放射性评估包括科布角,C7-SVA,骨盆曲和曲线位置通过站立的脊柱X射线.

主要成果:

在平均4.8年的随访期内,29.4%的患者出现了脊椎病的进展.
非缓解组表现出更大的基线和最终科布角,以及显著更高的年度进展率 (1.04°/年与0.59°/年对比).
进展的重大风险因素包括基线科布角≥10°,葡萄糖皮质激素使用和基线非缓解状态.

结论:

活跃的类风湿性关节炎疾病与脊椎病的进展有显著的相关性.
患有急性脊髓炎的患者呈现初始脊椎病变 (≥10°),需要葡萄糖皮质类药物,并且在活跃疾病中,患有脊椎病变进展的风险较高.

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