RA patients with cervical arthritis received inadequate therapy
About 5% percent of patients with rheumatoid arthritis who received outpatient therapy had cervical arthritis, and about half of them did not receive adequate treatment at diagnosis, according to study results.
Researchers in Germany conducted a cervical screening chart review of 395 patients with rheumatoid arthritis (RA) at an outpatient clinic during a 3-month period. These patients partially overlapped with eight patients who underwent C1–C2 fusion for RA cervical involvement from an orthopedic surgery department.
The charts for 67 patients (17%) did not include reports on cervical spine X-ray films; these included 21 (8%) of 257 with disease duration of at least 5 years. Seventeen of the 347 RA patients (5% of all outpatient patients with X-rays), however, had an atlantodental distance of more than 3 mm. Four other RA patients from the orthopedic surgery department fusion cohort were added for a total of 21 patients with cervical arthritis, 12 of whom were asymptomatic.
Erosive peripheral arthritis with at least 10 years of disease duration was indicated in all 21 cervical arthritis patients, and all were rheumatoid factor-positive.
“Almost half of these patients were not under adequate [disease-modifying antirheumatic drug] therapy when cervical instability was diagnosed, and none were on biological response modifiers,” the researchers reported.
“Despite novel therapeutic approaches, we have found cervical arthritis in approximately 5% of patients with rheumatoid arthritis seen at the division’s outpatient clinic,” the researchers concluded. “More than two-thirds of those patients were asymptomatic. Erosive seropositive rheumatoid factor with longer disease duration and inadequately controlled disease activity predicted increased risk.
“For this patient group, in particular, adherence to screening schedules for cervical arthritis is still essential, and regular monitoring for adherence to screening recommendations may be advisable.”
Disclosure: See the study for a full list of relevant disclosures.