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Open Access Research article

Clinical characteristics of rheumatoid arthritis patients undergoing cervical spine surgery: an analysis of National Database of Rheumatic Diseases in Japan

Shurei Sugita1*, Hirotaka Chikuda1, Yuho Kadono1, Hiroshi Ohtsu2, Katsushi Takeshita1, Jinju Nishino3, Shigeto Tohma4 and Sakae Tanaka1

Author Affiliations

1 The Department of Orthopaedic Surgery, The University of Tokyo, Hongo 7-3-1, Bunkyo, Tokyo, Japan

2 The Center for Lifetime Cancer Education, Juntendo University, Hongo 2-1-1, Bunkyo, Tokyo, Japan

3 Orthopaedic Surgeon, Nishino Clinic Orthopedics and Rheumatology, Nishigaoka 2-9-15, Kita, Tokyo, Japan

4 The Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization (NHO), Sakuradai 18-1, Sagamihara, Kanagawa, Japan

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BMC Musculoskeletal Disorders 2014, 15:203  doi:10.1186/1471-2474-15-203

Published: 13 June 2014

Abstract

Background

The aim of this study was to examine the clinical characteristics of rheumatoid arthritis (RA) patients who underwent cervical spine surgery using a multicenter observational database.

Methods

We obtained data from a nationwide observational cohort database of patients with rheumatic diseases (National Database of Rheumatic Diseases by iR-net in Japan (NinJa)) for the fiscal years 2003 to 2011. A total of 39 out of 60 patients who underwent cervical spine surgery for a RA-related cause and whose data were available for two consecutive years (to assess the preoperative patient status) were chosen as cases. Patients with a non-RA-related cause of surgery (e.g., trauma) were excluded. First, we compared the patient characteristics between the cases and total patients in the same fiscal year. Next, 106 eligible controls, who were defined as RA patients enrolled in the same fiscal year as the case subjects, who were matched for age, gender and disease duration (within ±1 year), were selected. We compared the demographic data between the two groups. We also calculated the percentage of patients who underwent cervical spine surgery (surgeries/total number of patients) in fiscal years 2003 to 2011.

Results

Although the proportion of patients using biologics linearly increased during study period, the percentage of patients undergoing cervical spine surgeries remained unchanged, at approximately 0.15%. These cases had more tender joints (3 vs. 1, p < 0.01) and exhibited a significantly higher Modified Health Assessment Questionnaire (MHAQ) score (1.13 vs. 0.5, p < 0.01), C-reactive protein (CRP) (1.5 vs. 0.36, p < 0.01), and disease activity score (DAS) 28-CRP (3.63 vs. 2.81, p < 0.01) compared to the controls.

Conclusions

Our study revealed that RA patients requiring cervical spine surgery have a higher disease activity (as represented by the DAS28-CRP) and are more functionally disabled (as represented by the MHAQ) than control patients.

Keywords:
Rheumatoid arthritis; Cervical spine surgery; Database