Tia Sandström1,2, Vappu Rantalaiho3,4, Timo Yli-Kerttula3,4, Hannu Kautiainen3,4, Timo Malmi3,4, Anna Karjalainen3,4, Tea Uusitalo3,4, Heikki Julkunen3,4, Oili Kaipiainen-Seppänen3,4, Leena Paimela3,4, Kari Puolakka3,4, Toini Uutela3,4, Timo Möttönen3,4, Pekka Hannonen3,4, Marjatta Leirisalo-Repo3,4, Leena Laasonen3,4, Markku Kauppi3,4. 1. From the Department of Rheumatology, and the Helsinki Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki; Centre for Rheumatic Diseases, Tampere University Hospital; Faculty of Medicine and Health Technology, Tampere University, Tampere; Department of Rheumatology, Satakunta Central Hospital, Rauma; Primary Health Care Unit, Kuopio University Hospital, Kuopio; Folkhälsan Research Center, Helsinki; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Rheumatology, Oulu University Hospital and University of Oulu, Oulu; Department of Medicine, Hämeenlinna Central Hospital, Hämeenlinna; Department of Medicine, Kuopio University Hospital, Kuopio, Finland; Orton Orthopaedic Hospital, Helsinki; South Karelia Central Hospital, Lappeenranta; Department of Medicine, Lapland Central Hospital, Rovaniemi; School of Medicine, University of Turku, Turku; Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä; Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland. tia.sandstrom@hus.fi. 2. T. Sandström, MD, Department of Rheumatology, Helsinki University Hospital and University of Helsinki; V. Rantalaiho, MD, PhD, Centre for Rheumatic Diseases, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University; T. Yli-Kerttula, MD, PhD, Department of Rheumatology, Satakunta Central Hospital; H. Kautiainen, BA, Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Center; T. Malmi, MD, Department of Medicine, Seinäjoki Central Hospital; A. Karjalainen, MD, PhD, Department of Rheumatology, Oulu University Hospital and University of Oulu; T. Uusitalo, MD, Department of Medicine, Hämeenlinna Central Hospital; H. Julkunen, MD, PhD, Department of Rheumatology, Helsinki University Hospital and University of Helsinki; O. Kaipiainen-Seppänen, MD, PhD, Department of Medicine, Kuopio University Hospital; L. Paimela, MD, PhD, Orton Orthopaedic Hospital; K. Puolakka, MD, PhD, South Karelia Central Hospital; T. Uutela, MD, PhD, Department of Medicine, Lapland Central Hospital; T. Möttönen, MD, Professor, School of Medicine, University of Turku; P. Hannonen, MD, Professor, Department of Rheumatology, Central Hospital of Central Finland; M. Leirisalo-Repo, MD, Professor, Department of Rheumatology, Helsinki University Hospital and University of Helsinki; L. Laasonen, MD, PhD, Helsinki Medical Imaging Center, Helsinki University Hospital and University of Helsinki; M. Kauppi, MD, Professor, Faculty of Medicine and Health Technology, Tampere University, and Department of Rheumatology, Päijät-Häme Central Hospital. tia.sandstrom@hus.fi. 3. From the Department of Rheumatology, and the Helsinki Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki; Centre for Rheumatic Diseases, Tampere University Hospital; Faculty of Medicine and Health Technology, Tampere University, Tampere; Department of Rheumatology, Satakunta Central Hospital, Rauma; Primary Health Care Unit, Kuopio University Hospital, Kuopio; Folkhälsan Research Center, Helsinki; Department of Medicine, Seinäjoki Central Hospital, Seinäjoki; Department of Rheumatology, Oulu University Hospital and University of Oulu, Oulu; Department of Medicine, Hämeenlinna Central Hospital, Hämeenlinna; Department of Medicine, Kuopio University Hospital, Kuopio, Finland; Orton Orthopaedic Hospital, Helsinki; South Karelia Central Hospital, Lappeenranta; Department of Medicine, Lapland Central Hospital, Rovaniemi; School of Medicine, University of Turku, Turku; Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä; Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland. 4. T. Sandström, MD, Department of Rheumatology, Helsinki University Hospital and University of Helsinki; V. Rantalaiho, MD, PhD, Centre for Rheumatic Diseases, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University; T. Yli-Kerttula, MD, PhD, Department of Rheumatology, Satakunta Central Hospital; H. Kautiainen, BA, Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Center; T. Malmi, MD, Department of Medicine, Seinäjoki Central Hospital; A. Karjalainen, MD, PhD, Department of Rheumatology, Oulu University Hospital and University of Oulu; T. Uusitalo, MD, Department of Medicine, Hämeenlinna Central Hospital; H. Julkunen, MD, PhD, Department of Rheumatology, Helsinki University Hospital and University of Helsinki; O. Kaipiainen-Seppänen, MD, PhD, Department of Medicine, Kuopio University Hospital; L. Paimela, MD, PhD, Orton Orthopaedic Hospital; K. Puolakka, MD, PhD, South Karelia Central Hospital; T. Uutela, MD, PhD, Department of Medicine, Lapland Central Hospital; T. Möttönen, MD, Professor, School of Medicine, University of Turku; P. Hannonen, MD, Professor, Department of Rheumatology, Central Hospital of Central Finland; M. Leirisalo-Repo, MD, Professor, Department of Rheumatology, Helsinki University Hospital and University of Helsinki; L. Laasonen, MD, PhD, Helsinki Medical Imaging Center, Helsinki University Hospital and University of Helsinki; M. Kauppi, MD, Professor, Faculty of Medicine and Health Technology, Tampere University, and Department of Rheumatology, Päijät-Häme Central Hospital.
Abstract
OBJECTIVE: To evaluate the development of radiological changes of the cervical spine in patients with rheumatoid arthritis (RA) in the NEO-RACo trial treated with an intensive, remission-targeted combination of conventional synthetic disease-modifying antirheumatic drugs (csDMARD) and additional infliximab (IFX) or placebo (PLA) for the first 6 months. METHODS: Ninety-nine patients with early, DMARD-naive RA were treated with a triple combination of csDMARD and prednisolone, and randomized to double-blindly receive either IFX (FIN-RACo+IFX) or PLA (FIN-RACo+PLA) infusions during the first 6 months. After 2 years the treatment strategies became unrestricted, but the treatment goal was strict NEO-RACo remission. At the 10-year visit, radiographs of the cervical spine were taken of 85 patients (38 in the FIN-RACo+IFX group and 47 in the FIN-RACo+PLA group). The study was registered at ClinicalTrials.gov (NCT00908089). RESULTS: There were 4/85 patients (4.7%) with cervical spine involvement (CSI) by 10 years. Atlantoaxial subluxation was found in 2/85 patients (2.4%), both in the FIN-RACo+IFX group, and none in the FIN-RACo+PLA group. Atlantoaxial impaction was found in 1/85 patients (1.2%) in the FIN-RACo+IFX group. Subaxial subluxation was found in 1/85 patients (1.2%). CONCLUSION: Early and intensive remission-targeted treatment has reduced the incidence of CSI and our results show that intensive treatment also prevents its development in the long run.
OBJECTIVE: To evaluate the development of radiological changes of the cervical spine in patients with rheumatoid arthritis (RA) in the NEO-RACo trial treated with an intensive, remission-targeted combination of conventional synthetic disease-modifying antirheumatic drugs (csDMARD) and additional infliximab (IFX) or placebo (PLA) for the first 6 months. METHODS: Ninety-nine patients with early, DMARD-naive RA were treated with a triple combination of csDMARD and prednisolone, and randomized to double-blindly receive either IFX (FIN-RACo+IFX) or PLA (FIN-RACo+PLA) infusions during the first 6 months. After 2 years the treatment strategies became unrestricted, but the treatment goal was strict NEO-RACo remission. At the 10-year visit, radiographs of the cervical spine were taken of 85 patients (38 in the FIN-RACo+IFX group and 47 in the FIN-RACo+PLA group). The study was registered at ClinicalTrials.gov (NCT00908089). RESULTS: There were 4/85 patients (4.7%) with cervical spine involvement (CSI) by 10 years. Atlantoaxial subluxation was found in 2/85 patients (2.4%), both in the FIN-RACo+IFX group, and none in the FIN-RACo+PLA group. Atlantoaxial impaction was found in 1/85 patients (1.2%) in the FIN-RACo+IFX group. Subaxial subluxation was found in 1/85 patients (1.2%). CONCLUSION: Early and intensive remission-targeted treatment has reduced the incidence of CSI and our results show that intensive treatment also prevents its development in the long run.