Risk prediction of degenerative scoliosis combined with lumbar spinal stenosis in patients with rheumatoid arthritis: a case–control study
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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.
KeywordsDegenerative scoliosis Lumbar spinal stenosis Rheumatoid arthritis Total knee arthroplasty
Lumbar spinal stenosis
Visual analog scale
American college of rheumatology
Body mass index
American society of anesthesiologists
Disease-modifying anti-rheumatic drugs
Total knee arthroplasty
Erythrocyte sedimentation rate: ESR
Non-steroidal anti-inflammatory drugs
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.
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.
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.
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