Journal article
The impact of steroids, methotrexate, and biologics on clinical and radiographic outcomes in patients with rheumatoid arthritis undergoing fusions at the craniovertebral junction
Journal of craniovertebral junction and spine, Vol.6(2), pp.60-64
04/2015
DOI: 10.4103/0974-8237.156044
PMCID: PMC4426523
PMID: 25972710
Abstract
Rheumatoid arthritis (RA) is an inflammatory disease that affects the craniovertebral junction (CVJ). Patients may suffer from atlantoaxial instability (AAI) and basilar invagination (BI) with variable presentations ranging from pain to quadriparesis. Managing these patients is often challenging due to their chronic use of steroids, methotrexate, and biologics; which impedes bone and wound healing. We report our experience with the surgical management of these patients undergoing fusions at the CVJ.
We conducted a retrospective study identifying all patients with the diagnosis of RA who underwent spinal fusions at our institution over the past 11 years. A total of 205 patients were identified amongst which 18 patients (8.8%) who underwent 20 fusions involving the CVJ. Demographic, clinical, and radiographic data were analyzed.
Five patients had AAI and 13 patients had BI. Two patients with C1-2 fusions underwent reoperation: One for pseudoarthrosis and one for BI. The average preoperative Nurick was 1.4 and improved to 0.5 postoperatively (P < 0.001). After conducting analyses stratified by dichotomous preoperative variables, the presence of steroids, methotrexate, biologics, and prednisone dosage less than 7.5 mg did not affect outcomes. Prednisone dosages ≥7.5 mg had significantly smaller improvements in Nurick score compared to patients not on steroids or on prednisone dosages <7.5 mg (0.40 vs 1.36, P = 0.042). Similarly, patients on biologics had significantly smaller improvements in Nurick score compared to patients not on biologics (0.27 vs 1.16, P = 0.038).
Fusions at the CVJ in patients with RA on daily prednisone dosages of less than 7.5 mg and/or methotrexate can be performed safely with good outcomes, fusion rates, and acceptable complication profiles. Daily prednisone dosages of more than 7.5 mg or biologics may impact clinical outcomes.
Details
- Title: Subtitle
- The impact of steroids, methotrexate, and biologics on clinical and radiographic outcomes in patients with rheumatoid arthritis undergoing fusions at the craniovertebral junction
- Creators
- Ryan Khanna - Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United StatesBrian J Dlouhy - Department of Neurological Surgery, University of Iowa, Carver School of Medicine, Iowa City, Iowa, United StatesZachary A Smith - Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United StatesSandi K Lam - Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas, United StatesTyler R Koski - Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United StatesNader S Dahdaleh - Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Resource Type
- Journal article
- Publication Details
- Journal of craniovertebral junction and spine, Vol.6(2), pp.60-64
- DOI
- 10.4103/0974-8237.156044
- PMID
- 25972710
- PMCID
- PMC4426523
- NLM abbreviation
- J Craniovertebr Junction Spine
- ISSN
- 0974-8237
- eISSN
- 0976-9285
- Publisher
- India
- Language
- English
- Date published
- 04/2015
- Academic Unit
- Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984040354102771
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