Factors influencing spinal sagittal balance, bone mineral density, and Oswestry Disability Index outcome measures in patients with rheumatoid arthritis
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To identify the factors influencing spinal sagittal alignment, bone mineral density (BMD), and Oswestry Disability Index (ODI) outcome measures in patients with rheumatoid arthritis (RA).
We enrolled 272 RA patients to identify the factors influencing sagittal vertical axis (SVA). Out of this, 220 had evaluation of bone mineral density (BMD) and vertebral deformity (VD) on the sagittal plane; 183 completed the ODI questionnaire. We collected data regarding RA-associated clinical parameters and standing lateral X-ray images via an ODI questionnaire from April to December 2012 at a single center. Patients with a history of spinal surgery or any missing clinical data were excluded. Clinical parameters included age, sex, body mass index, RA disease duration, disease activity score 28 erythrocyte sedimentation rate (DAS28-ESR), serum anti-cyclic citrullinated peptide antibody, serum rheumatoid factor, serum matrix metalloproteinase-3, BMD and treatment type at survey, such as methotrexate (MTX), biological disease-modifying anti-rheumatic drugs, and glucocorticoids. We measured radiological parameters including pelvic incidence (PI), lumbar lordosis (LL), and SVA. We statistically identified the factors influencing SVA, BMD, VD, and ODI using multivariate regression analysis.
Multivariate regression analysis showed that larger SVA correlated with older age, higher DAS28-ESR, MTX nonuse, and glucocorticoid use. Lower BMD was associated with female, older age, higher DAS28-ESR, and MTX nonuse. VD was associated with older age, longer disease duration, lower BMD, and glucocorticoid use. Worse ODI correlated with older age, larger PI-LL mismatch or larger SVA, higher DAS28-ESR, and glucocorticoid use.
In managing low back pain and spinal sagittal alignment in RA patients, RA-related clinical factors and the treatment type should be taken into consideration.
KeywordsSpinal sagittal alignment Oswestry Disability Index Rheumatoid arthritis Disease activity score Glucocorticoid Methotrexate
We wish to thank Dr. Fujii for his clinical data collection.
Compliance with ethical standards
Conflict of interest
For the present study, we received no payment or support in any aspect of the submitted work. However, outside the submitted work, there are several conflicts of interest, which are as follows: During this study, M. F., M. H, and M. T. belonged to the Department of the Control for Rheumatic Disease, which is financially supported by four pharmaceutical companies (Mitsubishi Tanabe, Chugai, Bristol-Myers Squibb, and Eisai). Five pharmaceutical companies (Pfizer, Astellas, AbbVie GK, Ayumi, Taisyo Toyama, and Eisai) provided scholarship donations to this center. M. H. received a research grant from Astellas. H. I. received research grants from Bristol-Myers Squibb, and Astellas. T. M. received grants from 8 pharmaceutical companies (Acterion, Ayumi, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, and Mitsubishi Tanabe) and payment for lectures from two pharmaceutical companies (Chugai and Mitsubishi Tanabe). K. M., B. O., S. F., K. S., S. L., H. Y., S. T., and S. M. declare no conflicts of interest for the present study.
The approval of the institutional ethics committee of Kyoto University was obtained for this study.
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