Spinal Issues in Patients With RA Linked to Poor Disease Control

Incidence of, and risk factors for, lumbar lesions in RA are examined in a longitudinal study.

Poorly controlled rheumatoid arthritis (RA) was an independent risk factors for de novo scoliosis, leading to worse lower back pain and quality of life in patient reports, according to findings from a prospective longitudinal cohort study published in Journal of Bone and Mineral Metabolism.

Investigators analyzed data from patients with RA at a single orthopedic outpatient RA clinic enrolled in the “analysis of factors for RA spinal disorders (AFFORD)” study from August 2010 to June 2011 who completed secondary data from July 2017 to March 2019 that included patient surveys, spinal radiography, and cervical and lumbar MRI. Investigators assessed the secondary data for new developments of spondylolisthesis, scoliosis, and vertebral fracture compared with baseline. They used a multivariable logistic regression model to obtain adjusted odds ratios (aORs), and propensity score analyses to investigate risk factors for incidence of scoliosis and vertebral fractures due to the small number of incident cases.

There were 110 patients included in the study with a mean age of 63 years; 89% were women. The incidence of spondylolisthesis, scoliosis, and vertebral fractures over a mean follow-up period of 7 years was 42%, 16% and 12%, respectively.

The use of glucocorticoids differed significantly between patients with and without spondylolisthesis in the univariate analysis, but not in the multivariate analysis. The baseline Disease Activity Score of 28 joints including C-reactive protein (DAS28-CRP) differed significantly between patients with and without new vertebral fracture in the univariate analysis, and the multivariate analysis showed glucocorticoid use as the risk factor for new vertebral fracture at secondary survey (aOR, 14.87; 95% CI, 1.79-123.58; P =.012).

Poor RA control, defined as deterioration of 1 level or more of disease activity or moderate/high disease activity at secondary survey, was a significant independent risk factor for de novo scoliosis (aOR, 4.81; P =.011). Patients with de novo scoliosis also reported significantly higher 100-mm visual analog scales (P =.001) for lower back pain and lower 5-level EuroQol 5 Dimension (EQ5D) scores (P =.043) for quality of life compared with patients without de novo scoliosis.

The study was limited by the lack of control participants without RA, small sample size, and that there were only 2 evaluation timepoints for the duration of the study.

“Control of disease activity without glucocorticoid administration might be important in preventing radiological lumbar disorders in RA,” the study authors wrote.

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Yamada K, Suzuki A, Takahashi S, et al. Incidence of and risk factors for spondylolisthesis, scoliosis, and vertebral fracture in rheumatoid arthritis. J Bone Miner Metab. Published online August 23, 2021. doi:10.1007/s00774-021-01261-y