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A multivariate analysis of risk factors for anterior atlantoaxial subluxation and an evaluation of the effect of glucocorticoid treatment on the upper rheumatoid cervical spine

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Summary

A cross-sectional, retrospective computerized analysis of risk factors for anterior atlantoaxial subluxation (AAS) was performed. Logistic regression performed on the clinical variables involved in 145 cases of rheumatoid arthritis (RA) disclosed a high joint score index and a low blood haemoglobin level as significant independent risk factors. This means that the development of anterior AAS is connected with widespread RA. Linear multiple regression analysis showed an association between the extent of anterior AAS in millimetres and the spread of erosions of the dens of axis and negative correlation with the severity of vertical atlantoaxial dislocation (VD). This suggests that whereas the presence of anterior AAS is connected with the severity of the systemic disease, its actual extent is associated with signs of local involvement, other than severe VD. The duration or cumulative dosage of glucocorticoids were not associated with the development or extent of anterior AAS, nor with the severity of vertical dislocation. This suggests that low dose glucocorticoid treatment is not involved with the development of rheumatoid changes in the upper cervical spine. It should be borne in mind, of course, that although no correlation was found, a causal relation cannot be excluded.

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References

  1. Ball, J., Sharp, J. Rheumatoid arthritis of the cervical spine. In: Modern Trends in Rheumatology, Vol. 2. Editor: Hill, A.G., New York, Appleton-Century-Crofts, 1971, 117–138.

    Google Scholar 

  2. Bland, J.H. Rheumatoid arthritis of the cervical spine. J Rheumatol 1974, 1, 319–341.

    Google Scholar 

  3. Santavirta, S., Kankaanpää, U., Sandelin, J.V., Laaksonen, E., Konttinen, Y.T., Slätis, P. Evaluation of patients with rheumatoid cervical spine. Scand J Rheumatol 1987, 16, 9–16.

    PubMed  Google Scholar 

  4. Smith, P.H., Benn, R.T., Sharp, J. Natural history of rheumatoid cervical luxation. Ann Rheum Dis 1972, 31, 431–439.

    PubMed  Google Scholar 

  5. Pellicci, P.M., Ranawat, C.S., Tsairis, P., Bryan, W.M.J. A prospective study of the progression of rheumatoid arthritis of the cervical spine. J Bone Joint Surg 1981, 36-A, 342–350.

    Google Scholar 

  6. Halla, J.T., Hardin, J.G., Vitec, J., Alarcón, G.S. Involvement of the cervical spine in rheumatoid arthritis. Arthritis Rheum 1989, 32, 652–659.

    PubMed  Google Scholar 

  7. Martel, W. The occipito-atlanto-axial joints in rheumatoid arthritis and ankylosing spondylitis. Am J Roentgenol 1961, 86, 223–240.

    Google Scholar 

  8. Eulderink, F., Meijers, K.A.E. Pathology of the cervical spine in rheumatoid arthritis: a controlled study of 44 spines. J Pathology 1976, 120, 91–108.

    Google Scholar 

  9. Stevens, J.C., Cartlidge, N.E.F., Saunders, M., Appleby, A., Hall, M., Shaw, D.A. Atlanto-axial subluxation and cervical myelopathy in rheumatoid arthritis. Q J Med 1971, 159, 391–408.

    Google Scholar 

  10. Crochard, H.A., Essigman, W.K., Stevens, J.M., Pozo, J.L., Ransford, A.O., Kendall, B.E. Surgical treatment of cervical cord compression in rheumatoid arthritis. Ann Rheum Dis 1985, 44, 809–816.

    PubMed  Google Scholar 

  11. Crochard, H.A., Pozo, J.L., Ransford, A.O., Stevens, J.M., Kendall, B.E., Essigman, W.K. Transoral decompression and posterior fusion for rheumatoid atlantoaxial subluxation. J Bone Joint Surg 1986, 68 B, 350–356.

    Google Scholar 

  12. Meijers, K.A.E., Cats, A., Kremer, H.P.H. Cervical myelopathy in rheumatoid arthritis. Clin Exp Rheumatol 1984, 2, 239–245.

    PubMed  Google Scholar 

  13. Althoff, B., Goldie, I.F. Cervical collars in rheumatoid atlantoaxial subluxation: a radiographic comparison. ann Rheum Dis 1980, 39, 485–489.

    PubMed  Google Scholar 

  14. Nakamo, K.K. Neurological complications of rheumatoid arthritis. Ortop Clin North Am 1975, 6, 861–881.

    Google Scholar 

  15. Rudge, S.R., Drury, P.L., Lloyd-Jones, J.K. Long-term corticosteroids and cervical subluxation in nonrheumatoid patients. Rheum Rehabil 1981, 20, 102–105.

    Google Scholar 

  16. Serre, H., Simon, L., Janicot, J.-Y., Levy, F. Les affections rhumatismales de la charniere cervico-occipitale. Rev Rhum 1963, 30, 518–544.

    PubMed  Google Scholar 

  17. Rasker, J.J., Cosh, J.A. Radiological study of cervical spine and hand in patients with rheumatoid arthritis of 15-year duration: an assessement of the effect of corticosteroid treatment. Ann Rheum Dis 1978, 37, 529–535.

    PubMed  Google Scholar 

  18. Arnett, F.C., Edworthy, S.M., Bloch, D.A., McShane, D.J., Fries, J.F., Cooper, N.S., Healey, L.A., Kaplan, S.R., Liany, M.H., Luthra, H.S., Medsger, T.A., Mitchell, D.M., Neustadt, D.H., Pinals, R.S., Schaller, J.G., Sharp, J.T., Wilder, R.L., Hunder, G.G. The American Rheumatism Association 1987 Revised Criteria for the Classification of Rheumatoid Arthritis. Arthritis Rheum 1988, 31, 315–324.

    PubMed  Google Scholar 

  19. Luukkainen, R. Chrysotherapy in rheumatoid arthritis. Scand J Rheumatol 1980, 34 (suppl), 1–56.

    Google Scholar 

  20. Redlund-Johnell, I., Pettersson, H. Radiographic measurements of the craniovertebral region. Acta Radiol 1984 35, 23–28.

    Google Scholar 

  21. Kauppi, M., Sakaguchi, M., Konttinen, Y.T., Hämäläinen, M. A new method of screening for atlantoaxial dislocation. J rheumatol 1990, 17, 167–172.

    PubMed  Google Scholar 

  22. Engelman, L. Stepwise logistic regression. In: BMDP Statistical Software Manual, Vol II, Editor: Dixon, W.J., Brown, M.B., Engelman, L. et. al., Berkeley, University of California Press, 1988, 941–970.

    Google Scholar 

  23. Afifi, A.A., Azen, S.P. Stepwise regression. In: Statistical analysis. A Computer Orientated Approach. New York, Academic Press 1979, 171–184.

    Google Scholar 

  24. Konttinen, Y.T., Bergroth, V., Santavirta, S., Sandelin, J. Inflammatory involvement of cervical spine ligaments in rheumatoid arthritis patients with atlanto-axial subluxation. J Rheumatol 1987, 14, 531–534.

    PubMed  Google Scholar 

  25. Santavirta, S., Hopfner-Hallikainen, D., Paukku, O., Sandelin, J., Konttnen, Y.T. Atlanto-axial facet joint arthritis in the rheumatoid cervical spine. J Rheumatol 1988, 15, 217–223.

    PubMed  Google Scholar 

  26. Kawaida, H., Sakou, T., Morizono, Y. Vertical settling in rheumatoid arthritis. Clin Orthop 1989, 239, 128–135.

    PubMed  Google Scholar 

  27. Winfield, J., Young, A., Williams, P., Corbett, M. Prospective study of the radiological changes in hands, feet and cervical spine in adult rheumatoid disease. Ann Rheum Dis 1983, 42, 613–618.

    PubMed  Google Scholar 

  28. Burke, S.W., French, H.G., Roberts, J.M., Johnston, C.E., Whitecloud, T.S., Edmunds, J.O. Chronic atlantoaxial instability in Down's syndrome. J Bone Joint Surg 1985, 67, 1356–1360.

    PubMed  Google Scholar 

  29. Lukert, B.P., Raisz, L.G. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Int Med 1990, 112, 352–364.

    PubMed  Google Scholar 

  30. Kröger, H., Karjalainen, P., Alhava, E.M. Low dose corticosteroids and cortical bone mass in RA. Scand J Rheumatol, 1190, Suppl. 85, 8.

    Google Scholar 

  31. Kröger, H., Arnala, I., Alhava, E.M. Effect of low dose corticosteroids on trabecular bone in rheumatoid arthritis. Scand J Rheumatol 1990, Suppl. 85, 8.

    Google Scholar 

  32. Ringe, J.D. Glucocorticoid-induced osteoporosis. Clin Rheumatol 1989, 8 Suppl. 2, 109–115.

    PubMed  Google Scholar 

  33. Reid, I.R. Pathogenesis and treatment of steroid osteoporosis. Clin Endocrinol 1989, 30, 83–103.

    Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Oulu University Central Hospital, Kajaanintie 50, 90220, Oulu, Finland

    M. Kauppi M.D.

  2. Fourth Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland

    M. Kauppi M.D., Y. T. Konttinen, V. Honkanen & M. Sakaguchi

  3. Rheumatism Foundation Hospital, Heinola, Finland

    M. Sakaguchi & M. Hamalainen

  4. Invalid Foundation, Orthopaedic Hospital, Helsinki, Finland

    S. Santavirta

  5. Kumamoto Orthopaedic Hospital, Kumamoto, Japan

    S. Santavirta

Authors
  1. M. Kauppi M.D.
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  2. Y. T. Konttinen
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  3. V. Honkanen
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  4. M. Sakaguchi
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  5. M. Hamalainen
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  6. S. Santavirta
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Kauppi, M., Konttinen, Y.T., Honkanen, V. et al. A multivariate analysis of risk factors for anterior atlantoaxial subluxation and an evaluation of the effect of glucocorticoid treatment on the upper rheumatoid cervical spine. Clin Rheumatol 10, 413–418 (1991). https://doi.org/10.1007/BF02206662

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  • DOI: https://doi.org/10.1007/BF02206662

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