RESEARCH - Rheumatoid atlantoaxial subluxation can be prevented by intensive use of traditional DMARDs

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J Rheumatol. 2009 Feb;36(2):273-8.

Rheumatoid atlantoaxial subluxation can be prevented by intensive use

of traditional disease modifying antirheumatic drugs.

Kauppi MJ, Neva MH, Laiho K, Kautiainen H, Luukkainen R, Karjalainen

A, Hannonen PJ, Leirisalo-Repo M, Korpela M, Ilva K, Möttönen T;

FIN-RACo Trial Group.

Rheumatism Foundation Hospital, 18120 Heinola, Finland.

OBJECTIVE: To evaluate the 5-year incidence of cervical spine

disorders in patients with early rheumatoid arthritis (RA) treated by

2 different disease modifying antirheumatic drug (DMARD) strategies.

METHODS: In a national, multicenter, prospective FIN-RACo-trial, a

cohort of 199 patients with early, clinically active RA was randomly

assigned to treatment with a combination of 3 DMARD and prednisolone

(Combi group) or with a single DMARD (Single group) with or without

prednisolone, aiming to induce remission. After 2 years, the DMARD

therapy was unrestricted. Lateral view cervical spine radiographs

during full flexion and extension were taken at the 5-year followup

visits. The presence of anterior atlantoaxial subluxation (aAAS),

atlantoaxial impaction (AAI), and subaxial subluxation (SAS) was

assessed in the 149 patients with radiographs available (80 Single and

69 Combi).

RESULTS: At the 5-year visits, aAAS, AAI, and SAS were found in 13

(9%), 6 (4%), and 9 (6%) patients, respectively. The corresponding

Single/Combi group ratios were 11/2, 5/1, and 5/4. Of the baseline

data, only poor physical function [Health Assessment Questionnaire

(HAQ); p = 0.024] and Single treatment strategy (p = 0.019) were

significantly associated with aAAS. Worse HAQ scores and Disease

Activity Score 28 values were found in patients who developed aAAS

during the 5-year followup.

CONCLUSION: RA patients with sustained clinical disease activity and

poor HAQ are at increased risk of developing aAAS. The development of

aAAS during the first 5 years of RA was rare among the patients

treated with a combination of DMARD for at least 2 years from the

diagnosis. Intensive treatment with traditional DMARD prevents or

retards the development of aAAS in patients with recent-onset RA.

PMID: 19132793

http://www.ncbi.nlm.nih.gov/pubmed/19132793

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