Prevalence of and factors associated with lumbar spondylolisthesis in patients with rheumatoid arthritis

Abstract

Objectives: To investigate the prevalence of and elucidate risk factors for lumbar spondylolisthesis in patients with rheumatoid arthritis (RA).

Methods: From 1843 patients registered to the Akita Orthopedic Group on Rheumatoid Arthritis registry, participants comprised 128 patients who had undergone comprehensive radiographic examinations. The presence of lumbar spondylolisthesis (≥5% slip percentage) was assessed from L1 to L5 on lateral plain radiographs. At the time of radiographic evaluation, we also determined the following: RA disease duration; stage and class of Steinbrocker’s classification; serum levels of C-reactive protein (CRP) and matrix metalloproteinase-3; disease activity for RA; history of joint surgery; the presence of cervical spinal instability; and details and doses of medications for RA.

Results: Forty-seven (36.7%) patients showed lumbar spondylolisthesis (L4, 48%; L3, 29%; L2, 13%; L5, 10%). Among these, Meyerding Grade was I in 89% and II in 11%. Multivariate analysis showed lumbar spondylolisthesis as significantly and independently associated with higher serum CRP level (odds ratio (OR), 1.50; 95% confidence interval (CI), 1.00–2.25; p = 0.048) and history of joint surgery (OR, 2.87; 95%CI, 1.22–6.72; p = 0.015).

Conclusions: More than one-third of patients with RA in this cohort had lumbar spondylolisthesis, and significant associations with higher serum CRP levels and history of joint surgery were identified.

Keywords:

• Lumbar spondylolisthesis
• Rheumatoid arthritis
• Risk factors

Acknowledgments

We wish to thank Drs. Toshiaki Aizawa, Hiroshi Aonuma, Nobuhiro Ishizawa, Hiroki Ito, Masakazu Urayama, Kunio Ebata, Masashi Oba, Masaaki Ogino, Takeshi Kashiwagura, Yoichi Kataoka, Keiji Kamo, Hiroaki Kijima, Koji Kudo, Natsuo Konishi, Moto Kobayashi, Tsutomu Sakuraba, Takeshi Sato, Tsuyoshi Shirahata, Kazuhiro Syoji, Norio Suzuki, Hiroshi Tazawa, Takayuki Tani, Yasuki Tamura, Syuichi Chida, Hiroyuki Tsuchie, Yoshihiro Tsutsumi, Takeshi Nagasawa, Tomio Nishi, Hideaki Noguchi, Koji Nozaka, Hiromi Morita, Shin Yamada, Kunitaka Yan, Hidetoshi Watanabe, and Wataru Watanabe in AORA for data collection.

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.