title: The relationship between cervical and lumbar spine lesions in rheumatoid arthritis with a focus on endplate erosion.
abstract: METHODS
  A cross-sectional imaging study.
  
  
  OBJECTIVE
  To investigate the relationship between cervical and lumbar spine lesions in patients with rheumatoid arthritis (RA), and to analyze associated factors in those with concurrent cervical and lumbar endplate erosion (EE).
  
  
  BACKGROUND
  Both the lumbar and cervical spines are often involved in RA, but little is known about the relationship between cervical and lumbar lesions. EE is often found in the spine of RA patients, but its prevalence and associated factors have not been well studied.
  
  
  METHODS
  We enrolled 201 RA patients in this study. Cervical lesions (horizontal and vertical atlantoaxial dislocation, subaxial subluxation) and lumbar lesions (vertebral fracture, scoliosis, spondylolisthesis) were evaluated on plain radiographs. EE was evaluated on sagittal T1-weighted magnetic resonance images, and graded into 4 categories. The prevalence of each lesion was calculated, and correlations between general cervical and lumbar lesions and between cervical and lumbar EE were analyzed. To assess the clinical condition of RA, we evaluated disease duration, Steinbrocker stage, modified Stanford Health Assessment Questionnaire results, and Disease Activity Score for 28 joints with the erythrocyte sedimentation rate. Factors associated with concurrent lumbar and cervical EE were analyzed using multiple logistic regression analysis.
  
  
  RESULTS
  Cervical lesions were found in 42.3% of patients and lumbar lesions in 56.2%. There was no significant correlation between the presence of cervical and the presence of lumbar lesions, but patients with cervical subaxial subluxation were significantly more likely to have lumbar spondylolisthesis. Cervical EE (≥1 points) was found in 61.2% of patients and lumbar EE in 39.3%. Total cervical EE score was significantly correlated with lumbar EE score. Moderate/high disease activity, Steinbrocker stage IV, and severe cervical or lumbar disk degeneration were associated with concurrent cervical and lumbar EE.
  
  
  CONCLUSIONS
  Some cervical lesions are significantly associated with lumbar spinal lesions. Concurrent cervical and lumbar EE are related to RA disease activity and peripheral joint deterioration, suggesting that RA activity may play an important role in total spinal involvement.
authors.affiliation: Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Akinobu
authors.initials: A
authors.lastname: Suzuki
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamada
authors.forename: Shinji
authors.initials: S
authors.lastname: Takahashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yasuda
authors.forename: Sho
authors.initials: S
authors.lastname: Dohzono
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Koike
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000473:pathology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000473:pathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000473:pathology; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000473:pathology