Cervical Spine Involvement is very rare in Patients with Rheumatoid Arthritis Treated actively with Treat to Target Strategy. Ten-Year Results of the NEORACo Study.
2019
Objective To evaluate the development of radiological changes of the cervical spine in patients with rheumatoid arthritis (RA) treated with intensive, remission-targeted combination of conventional synthetic (cs) disease modifying antirheumatic drugs (DMARDs) and additional infliximab or placebo for the first six months. Methods Ninety-nine patients with early, DMARD-naive RA were treated with a triple combination of csDMARDs and prednisolone, and randomized to double-blindly receive either infliximab (FIN-RACo+INFL) or placebo (FIN-RACo+PLA) infusions during the first 6 months. After 2 years the treatment strategies became unrestricted, but the treatment goal was strict NEO-RACo remission. At 10-year visit radiographs of the cervical spine were taken of 85 patients (38 in the FIN-RACo+INFL group and 47 in the FIN-RACo+PLA group). The study was registered at http://www.clintrials.gov (NCT 00908089). Results There were 4/85 patients (4.7%) with cervical spine involvement (CSI) by 10 years. Atlantoaxial subluxation was found in 2/85 patients (2.4%), 2 in the FINRACo+ INFL group and none in the FIN-RACo+PLA group. Atlantoaxial impaction was found in 1/85 patients (1.2%) in the FIN-RACo+PLA group. Subaxial subluxation was found in 1/85 patients (1.2%) Conclusion Early and intensive, remission-targeted treatment has decreased the incidence of CSI and our results show that intensive treatment prevents its development also in the longrun.
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