Lesion of the Spine in Rheumatoid Arthritis
Rheumatoid arthritis (RA) is one of the most common inflammatory joint diseases leading to persistent disability and early mortality of the patients, and one of the frequent manifestations of RA is a lesion of the spine, which significantly affects the quality of life of these patients. Objective: to evaluate spine lesion in patients with different types of RA course and factors that determine it.
Material and methods. We observed 131 patients with RA aged 18 to 79 years (mean 45 years), among whom there were 18 % men and 82 % women. Duration of the disease was 10 years, I radiographic stage of arthritis was detected in 8 % of cases of the disease, II — in 38 %, III — in 35 %, IV — in 19 %, seropositivity by the presence of rheumatoid factor was observed in 77 % of patients, and by the presence of anti-cyclic citrullinated peptide — in 3/4. Extra-articular (systemic) form of the disease occurred in 43 % of cases, systemic osteoporosis — in 67 %.
Results. Lesions of the spine in the form of osteochondrosis and spondyloarthrosis were detected in 1/2 of the patients with RA, and clinically overt ones occured in 35 % of cases that is directly correlated with the age of patients, involvement in the process of wrist, elbow, hip and sacroiliac joints, the presence of systemic osteoporosis and tendovaginitis, sensory and motor disorders due to peripheral neuropathy. Ratio of the incidence of mechanical, disfixation, disgemic and inflammatory pain in the spine in RA is a 1 : 2 : 6 : 14. Ossification of the outer layers of the intervertebral discs and the formation of syndesmophites, as well as spondylodiscitis are revealed on X-ray. Involvement of zygapophyseal joints is characterized by vagueness of the articular surfaces and fissures narrowing. Vertebral pathology has an influence on the symptoms of heart diseases (changes in electrical conductivity, the size of chambers, left ventricular diastolic function), vegetative changes and severity of neuropathy, and the predictors are the blood levels of rheumatoid factor and C-reactive protein.
Conclusions. Spondylopathy is a frequent manifestation of RA, it is correlated with many clinical and laboratory signs of the disease. In the future, early detection of the spine pathology will be useful in these patients for proper rehabilitation measures.
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