677 Do Flare-Ups in Systemic Disease Activity Correlate to Cervical Deformity in Patients With Rheumatoid Arthritis?

Abstract

INTRODUCTION: Following the introduction of biological DMARDs in Rheumatoid Arthritis (RA) treatment, cervical spine deformity seems to be less prevalent in those patients. It seems that this vast decline in patients with Atlanto-axial Subluxation (AAS), Subaxial Subluxation (SAS) or Vertical Subluxation (VS) is correlated to better control of systemic disease activity (DAS). The aim of the current study is to correlate the frequency of flare-ups in DAS to cervical spine deformity. METHODS: 272 RA patients were included and cervical deformity (AAS and/or SAS) was observed in 108 patients. 84 (31%) patients were in remission at 10 years FU and 206 (75%) of patients reached remission at least once during 10 years FU. Patients with cervical spine deformity at 10 years had less flare-ups (1.26) in DAS than patients without cervical spine deformity (1.58; 95% CI: 0.013-0.627). RESULTS: So, even though the BeSt Trial was designed to optimize treatment, 40% of the patients still developed RA-associated cervical spine deformity. However, remarkably, patients with more flares had less cervical deformity. This may be explained by the treatment regimen that anti-inflammatory medication is augmented upon measuring a systemic flare-up. CONCLUSIONS: This raises the hypothesis that RA medication treatment regimes should not be solely aimed at DAS values, as they are currently defined, in order to avoid cervical deformity in RA in the long term.