Akinobu Suzuki1, Koji Tamai2, Shinji Takahashi2, Kentaro Yamada2, Kentaro Inui2, Masahiro Tada3, Tadashi Okano2, Yuko Sugioka4, Tatsuya Koike5, Hiroaki Nakamura2. 1. Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. Electronic address: a-suzuki@msic.med.osaka-cu.ac.jp. 2. Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. 3. Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan. 4. Center for Senile Degenerative Disorders (CSDD), Osaka City University Graduate School of Medicine, Osaka, Japan. 5. Center for Senile Degenerative Disorders (CSDD), Osaka City University Graduate School of Medicine, Osaka, Japan; Search Institute for Bone and Arthritis Disease (SINBAD), Shirahama Foundation for Health and Welfare, Wakayama, Japan.
Abstract
BACKGROUND CONTEXT: Rheumatoid arthritis (RA) can affect the spine; however, the epidemiology of lumbar lesions and/or low back pain (LBP) in RA patients has not been well-studied. PURPOSE: The purpose of this study was to compare the prevalence of lumbar lesions and LBP in RA patients with that in healthy volunteers, and to elucidate the influence of RA on lumbar disease. STUDY DESIGN: Cross-sectional analysis in a cohort study with age- and sex-matched healthy volunteers. PATIENT SAMPLE: This study included 185 patients with RA and 188 gender/age-matched healthy volunteers without RA. OUTCOME MEASURES: Lumbar spondylolisthesis and prevalent vertebral fractures were evaluated using plain lateral X-ray images. Thoraco-lumbar scoliosis was evaluated using dual-energy X-ray absorptiometric images. LBP was assessed using the visual analogue scale (VAS) and Rolland-Morris disability questionnaire (RDQ). METHODS: The prevalence of radiological lumbar lesion and LBP was compared between the RA and control groups. In the RA group, factors associated with lumbar lesion and LBP were analyzed using a multiple logistic regression model. RESULTS: The prevalence rates of spondylolisthesis and prevalent vertebral fracture were significantly higher in the RA group than in the control group; the prevalence of thoraco-lumbar scoliosis tended to be higher in the RA group. There was no significant difference in the average LBP-VAS between the groups. However, the percentage of analgesic drug use was significantly higher, and RDQ scores tended to be worse in the RA group than the control group. Multivariate analysis revealed that age and disease activity score were both related to LBP in the RA group. CONCLUSIONS: RA patients are more likely to have radiological lumbar lesions. LBP in RA patients is well controlled, similar to the level in the healthy population; however, disease activity was related to LBP in RA patients. These results suggest that disease control is important for lumbar care in RA patients.
BACKGROUND CONTEXT: Rheumatoid arthritis (RA) can affect the spine; however, the epidemiology of lumbar lesions and/or low back pain (LBP) in RApatients has not been well-studied. PURPOSE: The purpose of this study was to compare the prevalence of lumbar lesions and LBP in RApatients with that in healthy volunteers, and to elucidate the influence of RA on lumbar disease. STUDY DESIGN: Cross-sectional analysis in a cohort study with age- and sex-matched healthy volunteers. PATIENT SAMPLE: This study included 185 patients with RA and 188 gender/age-matched healthy volunteers without RA. OUTCOME MEASURES: Lumbar spondylolisthesis and prevalent vertebral fractures were evaluated using plain lateral X-ray images. Thoraco-lumbar scoliosis was evaluated using dual-energy X-ray absorptiometric images. LBP was assessed using the visual analogue scale (VAS) and Rolland-Morris disability questionnaire (RDQ). METHODS: The prevalence of radiological lumbar lesion and LBP was compared between the RA and control groups. In the RA group, factors associated with lumbar lesion and LBP were analyzed using a multiple logistic regression model. RESULTS: The prevalence rates of spondylolisthesis and prevalent vertebral fracture were significantly higher in the RA group than in the control group; the prevalence of thoraco-lumbar scoliosis tended to be higher in the RA group. There was no significant difference in the average LBP-VAS between the groups. However, the percentage of analgesic drug use was significantly higher, and RDQ scores tended to be worse in the RA group than the control group. Multivariate analysis revealed that age and disease activity score were both related to LBP in the RA group. CONCLUSIONS:RApatients are more likely to have radiological lumbar lesions. LBP in RApatients is well controlled, similar to the level in the healthy population; however, disease activity was related to LBP in RApatients. These results suggest that disease control is important for lumbar care in RApatients.