Strukturne promjene na šakama kao prediktivni čimbenici strukturnih promjena na vratnoj kralježnici i atlanto-aksijalnom zglobu u bolesnika s reumatoidnim artritisom

Šahza Kikanović, Nedima Kapidžić-Bašić, Asja Hotić-Hadžiefendić, Dževad Džananović

Determination of changes in the cervical spine of patients with rheumatoid arthritis (RA) is important. Although they are often clinically asymptomatic, during exercise therapy complications, or even death, may occur. The aim of the study was to determine the factors which indicate
changes in the cervical spine and atlantoaxial joint (AA) in patients with RA, as well as the association between those changes and changes occurring on the hands. The study included 80 patients with RA who were divided into two groups according to the duration of the disease (up to 10 years and more than 10 years). Structural changes in the hands and cervical spine were monitored by ordinary radiography. Structural changes in the cervical
spine were found in both groups of patients without a statistically significant difference between them (p = 0.165). Th e AA joint was more often deformed in patients with a longer duration of the disease (p = 0.012). The changes on the hands were worse in patients who had the disease for longer than 10 years (p = 0.002), and they correlated with AA subluxation (p = 0.002) and luxation (p = 0.004), as well as with an erosion of the cervical
spine (p = 0.000). According to our findings, in order to recognize changes in the cervical spine, patients with RA must be regularly monitored radiographically, and monitoring should be mandatory in patients who had a longer duration of the disease as well as those with more advanced structural changes on the hands.

Utvrđivanje promjena vratne kralježnice važno je u bolesnika s reumatoidnim artritisom (RA), često je klinički asimptomatsko, a tijekom kineziterapije može doći do komplikacija, pa i smrti. Cilj rada bio je ustanoviti čimbenike koji upućuju na promjene vratne kralježnice i atlanto- aksijalnog zgloba (AA) u bolesnika s RA i njihovu povezanost s promjenama na šakama. Istraživanje je obuhvatilo 80 ispitanika s RA koji su podijeljeni u dvije grupe prema duljini trajanja bolesti (do 10 godina i više). Strukturne promjene šaka i vratne kralježnice praćene su nativnom radiografijom. Strukturne promjene na vratnoj kralježnici nađene su u obje grupe ispitanika, a bez statistički znatne razlike među njima (p = 0,165). AA-zglob češće je promijenjen u ispitanika s duljim trajanjem bolesti (p = 0,012). Promjene na šakama bile su veće u ispitanika s trajanjem bolesti više od 10 godina (p = 0,002) i korelirale su s AA-subluksacijom (p = 0,002) i luksacijom (p = 0,004) te s erozijama u području vratne kralježnice (p = 0,000). Na osnovi ovog istraživanja možemo zaključiti da u bolesnika s RA identificiranje promjena vratne kralježnice zahtijeva redovito radiografsko praćenje bolesnika i trebalo bi biti obvezatno kod duljeg trajanja bolesti i izraženih strukturnih promjena na šakama.