title: Clinical output of the rheumatoid cervical spine in patients with mutilating-type joint involvement: for better activities of daily living and longer survival.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  To gain an insight for the final clinical output of surgically managed cervical lesions in seropositive rheumatoid arthritis (RA) patients with mutilating-type joint involvement (mutilating-RA patients), these patients was followed up until either death or complete bedridden.
  
  
  BACKGROUND
  There has been no study reporting the final clinical output of surgically managed cervical lesion in mutilating-RA patients. In our previous study, we reported short- to middle-term result of such patient. The present study further traced those patients and reports the final clinical output.
  
  
  METHODS
  Seventeen seropositive mutilating-RA patients extracted from 504 RA patients were enrolled. Eleven patients underwent surgical treatments, whereas six patients did not. All patients, who underwent operation, have received occipitocervical or occipitocervicothoracic fusion. Neck pain, neurological symptoms and ADL score were completely followed up (i.e., follow-up period>10 years).
  
  
  RESULTS
  The six patients of non-operated group worsened ADL score and resulted in either complete bedridden or death within 3 years. Contrary, 11 operated patients either improved or maintained ADL until their death. Survival rate in 6.2 years was 0% in non-operated group and 27% in operated group, respectively. The present study suggests that the seropositive mutilating-RA patients worsen cervical lesions once they become affected, and are likely to lose their ADL activity.
  
  
  CONCLUSIONS
  Once seropositive mutilating-RA patients develop major spinal involvement(s), they are likely to undergo a life-threatening stage of the disease during the next 5-10 years. Surgical intervention is advocated not only to treat the neurological compromise but also to sustain their ADL levels during end stage of disease. The sustained ADL, in turn, may contribute to the longevity of these patients by preventing other major life-threatening events.
authors.affiliation: Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan. kanchi@belle.shiga-med.ac.jp
authors.forename: Kanji
authors.initials: K
authors.lastname: Mori
authors.forename: Shinji
authors.initials: S
authors.lastname: Imai
authors.forename: Kikuo
authors.initials: K
authors.lastname: Omura
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Saruhashi
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Matsusue
authors.forename: Sinsuke
authors.initials: S
authors.lastname: Hukuda
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000401:mortality; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors