Background Lumbar spine is considered as rarely involved in rheumatoid arthritis (RA). At variance, low back pain is commonly observed and is usually thought to be related to osteoporotic vertebral fractures.
Objectives To evaluate the prevalence of both vertebral fractures and lumbar discopathy in patients with RA and low back pain.
Patients-Methods Study design: Trans-sectionnal, case control radiological study. Patients: Two groups of patients were evaluated (RA and controls), all of them were suffering from low back pain defined as any back pain of the lumbar area which had occurred during the past 10 years. RA patients (ACR criteria) were in- or out- consecutive patients. Controls were consecutive patients without inflammatory rheumatic disorders for whom lumbar spine X-rays was indicated. Outcome measures: a) vertebral fractures, b) discopathy defined as a disc space narrowing using a 4 grade scale (Kappa statistics = 0.93 and 0.9 for intra- and inter-reproducibility, respectively). Marked discopathy was arbitrarily and a priori defined as a disc space narrowing of at least 66%. Analysis: All the films were blinded for patient’s identity and were allocated a number after randomization permitting an analysis by two trained observers unaware of the group of patients (i.e., RA or controls).
Results Of the 123 recruited patients, 53 were suffering for RA (57 ± 13 years old, 79% females) and 70 defined the control group (55 ± 13 years old, 81% females). An osteoporotic vertebral fracture was observed in 8 RA patients and never in the control group (p = 0.002). A marked discopathy was observed in 20 (38%) and in 13 (19%) patients in the RA and control group respectively (p = 0.017).
Conclusion This study confirms the higher prevalence of osteoporotic vertebral fracture in RA but also suggests that lumbar discopathy might be involved in the occurrence and severity of low back pain in RA.
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