Active Rheumatoid Arthritis and Scoliosis: A Mid-Term Cohort Study.

Abstract

Retrospective cohort study. To elucidate the factors related to the progression of scoliosis in patients with rheumatoid arthritis (RA) using longitudinal cohort data. Of patients, 30% with RA have lumbar scoliosis. However, the effectiveness of current treatment methods in preventing the progression of scoliosis is not well understood due to a lack of longitudinal studies. We enrolled 180 patients with RA who were followed up for over 2 years, all of whom underwent standing spinal x-rays. These patients were categorized based on their disease activity score-28 with erythrocyte sedimentation rate into 2 groups: (1) those in remission (n = 76) and (2) those in nonremission (n = 104). We evaluated various radiographic measures, including C7 center sacral vertical line, pelvic obliquity, major Cobb angle, and curve location. Fifty-three (29.4%) patients presented progression of scoliosis during a mean follow-up period of 4.8 years. Patients in the nonremission showed larger Cobb angle at baseline and final follow-up, compared with those in remission. The annual progression rate of the curve was also greater in the nonremission group (1.04°/yr) than in the remission group (0.59°/yr, P = 0.001). There was no difference in the incidence of new vertebral fractures. The presence of a baseline Cobb angle of 10° or more [odds ratio (OR): 3.14; 95% CI: 1.38-7.13; P = 0.006], glucocorticoid use (OR: 2.88; 95% CI: 1.18-7.06; P = 0.021), and nonremission at baseline (OR: 2.83; 95% CI: 1.25-6.41; P = 0.012) were significant risk factors for progression of scoliosis. RA disease activity is linked to the progression of scoliosis in patients with RA. Patients with RA who present with initial scoliosis of ≥10°, require glucocorticoids for treatment and are in nonremission at baseline may be at high risk for scoliosis progression. Level III.