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Risk prediction of degenerative scoliosis combined with lumbar spinal stenosis in patients with rheumatoid arthritis: a case–control study

  • Shuai Xu
  • Yan Liang
  • Fanqi Meng
  • Zhenqi Zhu
  • Haiying LiuEmail author
Observational Research
  • 31 Downloads

Abstract

The purpose of this study is to compare incidence of degenerative scoliosis (DS) in patients who diagnosed lumbar spinal stenosis (LSS) with or without rheumatoid arthritis (RA) and identify the risk factors of DS severity in RA patients. 61 LSS patients with RA (RA group) and 87 demographic-matched LSS patients without RA (NoRA group) from January 2013 to April 2018 were enrolled. The extracted information includes RA-related parameters such as Steinbrocker classification, disease-modifying anti-rheumatic drugs (DMARDs), and DS-related information such as Cobb angle, apical vertebra, along with osteoporosis and history of total knee arthroplasty (TKA). Comparisons between RA and NoRA group and between DS and non-DS subgroup with RA were performed, as well as the risk factors on DS severity in RA patients. The incidence of DS in RA group was 42.6%, larger than that of NoRA group (P = 0.002). The mean Cobb angle between the two groups was of no difference (P = 0.076). The apical vertebrae were both mainly focused on L3 and L4 vertebrae in both groups with no significant difference on the distribution of apical vertebrae (P = 0.786). Female took a larger proportion in DS subgroup than that of NoDS subgroup in patients with RA (P = 0.039), while Steinbrocker classification was irrelevant to the occurrence of DS and Cobb angle. Multiple regression analysis showed that TKA was a risk factor for the severity of Cobb angle (P = 0.040). The incidence of DS in LSS patients with RA is higher than non-RA patients. RA patients performed TKA sustained less severity of DS.

Keywords

Degenerative scoliosis Lumbar spinal stenosis Rheumatoid arthritis Total knee arthroplasty 

Abbreviations

RA

Rheumatoid arthritis

DS

Degenerative scoliosis

LSS

Lumbar spinal stenosis

VAS

Visual analog scale

ACR

American college of rheumatology

BMI

Body mass index

ASA

American society of anesthesiologists

DMARDs

Disease-modifying anti-rheumatic drugs

TKA

Total knee arthroplasty

ESR

Erythrocyte sedimentation rate: ESR

NSAIDs

Non-steroidal anti-inflammatory drugs

Notes

Acknowledgements

We acknowledge Houshan Lv and Kaifeng Wang who contributed towards the study by making substantial contributions to the design and the acquisition of data. We also acknowledge American Journal Experts (AJE) for editing-support.

Author contributions

According to the ICMJE 4 authorship criteria, Haiying Liu, Shuai Xu, and Yan Liang made substantial contributions to the conception or design of the work; Shuai Xu, Yan Liang, Fanqi Meng, and Haiying Liu finished the acquisition for this work; Shuai Xu, Yan Liang, and Zhenqi Zhu finished analysis and interpretation of data for the work; Haiying Liu and Zhenqi Zhu were responsible for drafting the work or revising it critically for important intellectual content; Zhenqi Zhu and Haiying Liu put the final approval of the version to be published; Shuai Xu and Haiying Liu exerted agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors declared that no part of the manuscript was copied or published elsewhere and all co-authors take full responsibility for the correctness of the data and the integrity of the final manuscript.

Funding

National Key R&D Program of China (grant number: 2016YFC0105606).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

This study has obtained ethics approval and consent of the ethics committee in our hospital. The ethical approval protocol number was 2018PHC076 and it began from the December 13th, 2018.

References

  1. 1.
    Seki S, Hirano N, Matsushita I et al (2018) Lumbar spine surgery in patients with rheumatoid arthritis (RA): what affects the outcomes? SPINE J 18(1):99–106.  https://doi.org/10.1016/j.spinee.2017.06.030 CrossRefPubMedGoogle Scholar
  2. 2.
    Wolfs JF, Kloppenburg M, Fehlings MG et al (2009) Neurologic outcome of surgical and conservative treatment of rheumatoid cervical spine subluxation: a systematic review. Arthritis Rheum 12:1743–1752.  https://doi.org/10.1002/art.25011 CrossRefGoogle Scholar
  3. 3.
    Shen FH, Samartzis D, Jenis LG et al (2004) Rheumatoid arthritis: evaluation and surgical management of the cervical spine. Spine J 6:689–700.  https://doi.org/10.1016/j.spinee.2004.05.001 CrossRefGoogle Scholar
  4. 4.
    Kothe R, Kohlmann T, Klink T et al (2007) Impact of low back pain on functional limitations, depressed mood and quality of life in patients with rheumatoid arthritis. Pain 1–2:103–108.  https://doi.org/10.1016/j.pain.2006.08.011 CrossRefGoogle Scholar
  5. 5.
    Mitsuyama T, Kubota M, Yuzurihara M et al (2013) The pitfalls in surgical management of lumbar canal stenosis associated with rheumatoid arthritis. Neurol Med Chir (Tokyo) 12:853–860.  https://doi.org/10.2176/nmc.oa2012-0299 CrossRefGoogle Scholar
  6. 6.
    Ohishi M, Miyahara H, Kondo M et al (2014) Characteristics of lumbar scoliosis in patients with rheumatoid arthritis. J Orthopaed Surgery Res.  https://doi.org/10.1186/1749-799X-9-30 CrossRefGoogle Scholar
  7. 7.
    Makino T, Kaito T, Fujiwara H et al (2013) Lumbar scoliosis in rheumatoid arthritis: epidemiological research with a DXA cohort. Spine (Phila Pa 1976) 6:E339–E343.  https://doi.org/10.1097/BRS.0b013e3182843397 CrossRefGoogle Scholar
  8. 8.
    Mesfin A, El DM, Jain A et al (2015) Surgical outcomes of long spinal fusions for scoliosis in adult patients with rheumatoid arthritis. J Neurosurg Spine 4:367–373.  https://doi.org/10.3171/2014.10.SPINE14365 CrossRefGoogle Scholar
  9. 9.
    Aletaha D, Neogi T, Silman AJ et al (2010) Rheumatoid arthritis classification criteria: an american college of rheumatology/european league against rheumatism collaborative initiative. Arthritis Rheum 9:2569–2581.  https://doi.org/10.1002/art.27584 CrossRefGoogle Scholar
  10. 10.
    Steinbrocker O, Traeger CH, BATTERMAN RC (1949) Therapeutic criteria in rheumatoid arthritis. J Am Med Assoc 140(8):659–662.  https://doi.org/10.1001/jama.1949.02900430001001 CrossRefPubMedGoogle Scholar
  11. 11.
    Wegierska M, Dura M, Blumfield E et al (2016) Osteoporosis diagnostics in patients with rheumatoid arthritis. Reumatologia 54(1):29–34.  https://doi.org/10.5114/reum.2016.58759 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Yamada K, Suzuki A, Takahashi S et al (2014) MRI evaluation of lumbar endplate and facet erosion in rheumatoid arthritis. J Spinal Disord Tech 4:E128–E135.  https://doi.org/10.1097/BSD.0b013e3182a22a34 CrossRefGoogle Scholar
  13. 13.
    Kohno S, Ikeuchi M, Taniguchi S et al (2011) Factors predicting progression in early degenerative lumbar scoliosis. J Orthop Surg (Hong Kong) 2:141–144.  https://doi.org/10.1177/230949901101900202 CrossRefGoogle Scholar
  14. 14.
    van Onna M, Boonen A (2016) The Challenging Interplay Between Rheumatoid Arthritis Ageing and Comorbidities. BMC Musculoskelet Disord.  https://doi.org/10.1186/s12891-016-1038-3 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Confavreux CB, Chapurlat RD (2011) Systemic bone effects of biologic therapies in rheumatoid arthritis and ankylosing spondylitis. Osteoporos Int 4:1023–1036.  https://doi.org/10.1007/s00198-010-1462-4 CrossRefGoogle Scholar
  16. 16.
    Mawatari T, Miura H, Hamai S et al (2008) Vertebral strength changes in rheumatoid arthritis patients treated with alendronate, as assessed by finite element analysis of clinical computed tomography scans: a prospective randomized clinical trial. Arthritis Rheum 11:3340–3349.  https://doi.org/10.1002/art.23988 CrossRefGoogle Scholar
  17. 17.
    Suzuki Y, Nawata H, Soen S et al (2014) guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the japanese society for bone and mineral research: 2014 update. J Bone Miner Metab 4:337–350.  https://doi.org/10.1007/s00774-014-0586-6 CrossRefGoogle Scholar
  18. 18.
    Resnick D (1978) Thoracolumbar spine abnormalities in rheumatoid arthritis. Ann Rheum Dis 4:389–391.  https://doi.org/10.1136/ard.37.4.389-b CrossRefGoogle Scholar
  19. 19.
    Oda T, Fujiwara K, Yonenobu K et al (1995) Natural course of cervical spine lesions in rheumatoid arthritis. Spine (Phila Pa 1976) 10:1128–1135.  https://doi.org/10.1097/00007632-199505150-00004 CrossRefGoogle Scholar
  20. 20.
    Schils JP, Resnick D, Haghighi PN et al (1989) Pathogenesis of discovertebral and manubriosternal joint abnormalities in rheumatoid arthritis: a cadaveric study. J Rheumatol 3:291–297Google Scholar
  21. 21.
    Sakai T, Sairyo K, Hamada D et al (2008) Radiological features of lumbar spinal lesions in patients with rheumatoid arthritis with special reference to the changes around intervertebral discs. Spine J 4:605–611.  https://doi.org/10.1016/j.spinee.2007.03.008 CrossRefGoogle Scholar
  22. 22.
    Singh JA, Furst DE, Bharat A et al (2012) 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken) 64:625–639.  https://doi.org/10.1002/art.23721 CrossRefGoogle Scholar
  23. 23.
    Kim SC, Yelin E, Tonner C et al (2013) Changes in use of disease modifying anti-rheumatic drugs for rheumatoid arthritis in the United States during 1983–2009. Arthritis Care Res (Hoboken) 65:1529–1533.  https://doi.org/10.1002/acr.21997 CrossRefGoogle Scholar
  24. 24.
    Bernstein DN, Kurucan E, Menga EN et al (2018) Comparison of adult spinal deformity patients with and without rheumatoid arthritis undergoing primary non-cervical spinal fusion surgery: a nationwide analysis of 52,818 patients. Spine J.  https://doi.org/10.1016/j.spinee.2018.03.020 CrossRefPubMedGoogle Scholar
  25. 25.
    Terashima Y, Yurube T, Hirata H et al (2017) Predictive risk factors of cervical spine instabilities in rheumatoid arthritis: a prospective multicenter over 10-year cohort study. Spine (Phila Pa 1976) 8:556–564.  https://doi.org/10.1097/BRS.0000000000001853 CrossRefGoogle Scholar
  26. 26.
    Grauer JN, Tingstad EM, Rand N et al (2004) Predictors of paralysis in the rheumatoid cervical spine in patients undergoing total joint arthroplasty. J Bone Joint Surgery Am 7:1420–1424.  https://doi.org/10.2106/00004623-200407000-00009 CrossRefGoogle Scholar
  27. 27.
    Collins DN, Barnes CL, FitzRandolph RL (1991) Cervical spine instability in rheumatoid patients having total hip or knee arthroplasty. Clin Orthop Relat Res 272:127–135.  https://doi.org/10.1097/00003086-199111000-00019 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Spinal SurgeryPeking University People’s Hospital, Peking UniversityBeijingP.R. China

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