High Mortality Rate in Rheumatoid Arthritis With Subluxation of the Cervical Spine

Abstract

RA with neck involvement is a progressive and serious condition with reduced lifetime expectancy. Hence, our interpretation is that operative intervention improves local symptoms and most likely changes the condition from worse to better by increasing lifetime expectancy in high risk patients. Since the per- and postoperative complications are few, a changed attitude toward more liberal indications for earlier surgery may reduce the symptoms and the mortality rate even more.

Increased Mortality Rate in Rheumatoid Arthritis Patients with Neurological Symptoms or Signs Secondary to Cervical Spine Subluxations – Reduced Mortality if Postoperative Ankylosis is Achieved

“…When the cervical spine is involved this risk is increased (Paus et al, 2008;Riise et al, 2001;Shen et al, 2004). In the RA population the estimates of the number of patients with cervical involvement varies from 12% (Naranjo et al, 2004) to 57% (Neva et al, 2006).…”

“…Secondarily we wanted to disclose important factors affecting the mortality rate in operated RA patients with neurology. The results for the total RA population with cervical subluxations (n=532) treated during the same 25 year period (217 operated and 315 non-operated) have been published previously (Paus et al, 2008).…”

Statistics in Brief: An Introduction to the Use of Propensity Scores

“…Propensity score techniques were introduced in 1983 [21], and to the best of our knowledge, first used in an article in an orthopaedic journal in 2008 [16]. In a brief review of the contemporary orthopaedic literature (2000 to July 2013, PubMed, English-language only), we found more than 30 articles using the propensity score in their analyses.…”

Rheumatoid vertical and subaxial subluxation can be prevented by atlantoaxial posterior screw fixation

“…In subaxial lesions, the occurrence of SAS may be related to not only the state of RA, but also to the development of upper cervical lesion. Although diseasemodifying antirheumatic drugs (DMARDs) have had a major impact on the natural history including cervical involvement [4], these subluxations may ultimately cause compression of the brain stem and/or spinal cord leading to myelopathy, and in the worst cases even to quadriplegia or sudden death [5][6][7]. Therefore, successful timely management of AAS is considered to be important.…”