Assessment of cervical pain and function in patients with rheumatoid arthritis.
Rheumatoid arthritis (RA) is characterized by inflammation of the synovial membrane, which can lead to deformities and functional disability. Unlike the dorsal and lumbar spine, the cervical spine is often affected by RA. The objective of this paper is to assess cervical pain and function in patients with RA and correlate these variables with overall function, quality of life, and radiographic findings on the cervical spine. One hundred individuals aged 18 to 65 years were divided into study group (50 patients with rheumatoid arthritis) and control group (50 healthy individuals, paired for gender and age). Patients with prior surgery, prior trauma or other symptomatic cervical spine condition were excluded. The visual analogue pain scale (VAS), Neck Pain and Disability Scale (NPDS), SF-36, HAQ and X-rays were used for evaluation purposes. Mean disease duration was 11.1 years. The cervical VAS was 2.4 cm and 1.3 cm for the study and control groups, respectively (p = 0.074). Statistical differences were found in NPDS scores, mean = 26.7 and 6.9, and HAQ scores, mean = 1.1 and 0.1, for the study and control groups, respectively (p < 0.001). SF-36 scores were statistically worse in the study group, except for the vitality, social aspects and mental health subscales. There was a positive correlation between the NPDS and VAS (r = 0.54) and between the NPDS and HAQ (r = 0.67). There was a negative correlation between the NPDS and SF-36 functional capacity domain (r = -0.53) and physical limitation domain (r = -0.58). The radiographic findings revealed more prevalent anterior atlanto-axial subluxation (p = 0.030), listhesis in neutral posture (p = 0.037), listhesis in extension (p = 0.007), degenerative alteration of C4-C5 segment (p = 0.023), size of C2 spinal canal (p = 0.002) and C3 spinal canal (p = 0.029) in the study group. Patients with RA have poorer cervical function than healthy individuals, although there is no difference in cervical pain.
Division of Rheumatology, Federal University of São Paulo, Rua Botucatu 740, 04023-900, São Paulo, SP, Brazil.
Marcelo Cardoso
MC
de Souza
Eloy
E
de Ávila Fernandes
Anamaria
A
Jones
Império
I
Lombardi
Jamil
J
Natour
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000503:physiopathology*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000503:physiopathology*; D010147:Pain Measurement; D011788:Quality of Life; D011859:Radiography
Spine (Phila Pa 1976). 1995 May 15;20(10):1128-35
7638655
Ann Rheum Dis. 2006 Jul;65(7):884-8
16269427
Disabil Rehabil. 2002 May 10;24(7):364-70
12022786
J Bone Joint Surg Am. 1979 Oct;61(7):1003-10
489640
Scand J Rheumatol. 1987;16(1):9-16
3296160
J Rheumatol. 1990 Jun;17(6):813-7
2388204
Rev Rhum Ed Fr. 1993 Jul-Sep;60(7-8):539-42
8148857
Med Pregl. 2009 May-Jun;62(5-6):273-7
19650566
Spine (Phila Pa 1976). 2004 Nov 15;29(22):2485-92
15543059
Br J Rheumatol. 1994 Aug;33(8):735-9
8055200
Ann Rheum Dis. 1957 Dec;16(4):494-502
13498604
Ann Rheum Dis. 2005 Mar;64(3):355-8
15708890
Spine (Phila Pa 1976). 2002 Mar 1;27(5):515-22
11880837
Arthritis Rheum. 2003 Jul;48(7):1808-13
12847673
Joint Bone Spine. 2004 Jul;71(4):317-26
15288858
Spine (Phila Pa 1976). 2006 Jun 15;31(14):1621-7
16778699
Clin Rheumatol. 2002 Jun;21(3):227-30
12111629
Arthritis Rheum. 1988 Mar;31(3):315-24
3358796
Eur Spine J. 2006 Mar;15(3):283-91
15968527
Spine (Phila Pa 1976). 2000 Aug 15;25(16):2072-8
10954638
BMJ. 1996 Sep 7;313(7057):601-2
8806252
Pain. 2004 Aug;110(3):639-645
15288404
Clin Exp Rheumatol. 1994 Jul-Aug;12(4):369-74
7955599
Spine (Phila Pa 1976). 1998 Oct 1;23(19):2052-6
9794048
Rheumatol Int. 2006 Feb;26(4):320-4
15986086
Lancet. 1974 Nov 9;2(7889):1127-31
4139420
Br J Gen Pract. 1996 Sep;46(410):519-23
8917870