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Master Thesis

Prevalence and prediction factor of atlanto:axial subluxation in early polyarthritis (Espoir cohort)

Abstract : Atlantoaxial subluxation (aAAS) has been reported in rheumatoid arthritis (RA). We don’t know whether and when cervical x-rays could be of interest in the follow up. Objectives : the aims of this work were first to define, in the ESPOIR cohort, the prevalence of aAAS with AADI/O ratio, at 12 years of development of polyarthritis. The secondary objectives were to look for predictive factors of aAAS. Methods : dynamic spine radiographs were retrospectively and independently analyzed by two observers. For each radiograph, the odontoid sagittal diameter (O) and the anterior atlanto-dental interval (AADI) were measured in pixels to obtain AADI/O. The cut-off AADI/O > 0.229 which correspond to an AADI>2.99 was chosen to defined aAAS. We then investigated clinical, biological, radiological factors at inclusion and 10 years to find which could predict aAAS at 12 years. Results : 323 patients were included. 15 patients had an aAAS. At the inclusion visit, only the presence of IgA RF was statistically associated with aAAS (p = 0.025). CRP>6mg/L (9/15 vs 58/295; p = 0.001) and Rheumatoid factor (13/15 vs 152/299; p = 0.007) at ten years are statistically associated with aAAS at 12 years. Conclusion : the prevalence of aAAS is 4.6% in the ESPOIR cohort. Given the low incidence of aAAS, systematic screening would have a low yield. It seems difficult to predict which patient is at risk of aAAS in early arthritis. The presence of rheumatoid factor and CRP over 6mg/L at 10 years could be interesting factors to guide the prescription of dynamic cervical x-rays. Key points : the aim of this study was to evaluate the prevalence of anterior atlanto-axial subluxation using ratios on plain radiograph.
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Master Thesis
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Submitted on : Wednesday, December 8, 2021 - 12:10:06 PM
Last modification on : Saturday, February 12, 2022 - 3:16:04 AM
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Aurore Le Quellec. Prevalence and prediction factor of atlanto:axial subluxation in early polyarthritis (Espoir cohort). Life Sciences [q-bio]. 2021. ⟨dumas-03470512⟩



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