The association between Disease Activity Score and rheumatoid arthritis–associated cervical deformity: radiological evaluation of the BeSt trial

Anna B. Lebouille-VeldmanDepartments of Neurosurgery and

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Dylan SpenkelinkBiomedical Engineering, University of Twente, The Netherlands;

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Cornelia F. AllaartRheumatology, Leiden University Medical Centre, Leiden, The Netherlands;

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 MD, PhD
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Carmen L. A. Vleggeert-LankampDepartments of Neurosurgery and
Department of Neurosurgery, The Hague Medical Centre and HAGA Teaching Hospital, The Hague, The Netherlands; and
Department of Neurosurgery, Spaarne Hospital Haarlem/Hoofddorp, The Netherlands

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OBJECTIVE

The authors’ objective was to evaluate the association of the Disease Activity Score (DAS) with cervical spine deformity in rheumatoid arthritis (RA) patients during 10-year optimal treatment of systemic disease.

METHODS

The authors evaluated radiological and 10-year follow-up (FU) data of the BeSt (BehandelStrategien) trial. In 272 RA patients, atlantoaxial subluxation (AAS), presence of vertical translocation (VT), and subaxial subluxation (SAS) were evaluated. The associations of these deformities with DAS, self-assessed health (determined with the Health Assessment Questionnaire [HAQ]), and erosions of the hands and feet (Sharp–Van der Heijde score) were studied.

RESULTS

After 10 years of FU, AAS (> 2 mm neutral position) was observed in 62 patients (23%), AAS (≥ 3 mm in flexion) in 24%, AAS (≥ 5 mm in flexion) in 7%, VT did not occur, and SAS was present in 60 patients (22%). In total, 135 patients (50%) were in remission (DAS < 1.6) at 10 years of FU. No association could be established between AAS and DAS. Patients with cervical spine deformity (AAS > 2 mm and/or SAS) at 10 years had a higher HAQ score at 10 years than patients without cervical spine deformity (HAQ scores of 0.65 and 0.51, respectively, p = 0.04; 95% CI –0.29 to 0.00).

CONCLUSIONS

Even though 50% of patients were in remission after 10 years and the BeSt trial was designed to optimize treatment, 40% of patients developed at least mild RA-associated cervical spine deformity and 7% developed significant AAS. This indicates that even in this era of disease-modifying antirheumatic drugs and biologicals, cervical deformity is prevalent among patients with RA and should not be neglected in patient treatment plans and information.

ABBREVIATIONS

AAS = atlantoaxial subluxation; ACPA = anticitrullinated protein antibody; BeSt = BehandelStrategien; DAS = Disease Activity Score; DAS44 = DAS measured on 44 joints; DMARD = disease-modifying antirheumatic drug; FU = follow-up; HAQ = Health Assessment Questionnaire; RA = rheumatoid arthritis; RF = rheumatoid factor; SAS = subaxial subluxation; SHS = Sharp–Van der Heijde score; VT = vertical translocation.
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