Background Much is understood about cervical lesions in rheumatoid arthritis (RA) whereas the prevalence of lumbar lesions in RA has not been studied in detail.

Objectives The present study assessed lumbar lesions in patients with RA and evaluates related factors.

Methods This study included 262 (216 women and 46 men) patients who fulfilled the revised criteria of the American College of Rheumatology. The background of RA was assessed based on age, duration of disease, low back pain assessed using a visual analog scale (VAS), DAS-28 ESR, and RA stage and class determined based on by Steinbrocker’s criteria. We examined the prevalence of lumbar lesions comprising degenerative lumbar scoliosis (DLS), lumbar spondylolisthesis (LS) and vertebral fractures (VF) on plain X-rays and analyzed correlations with background factors.

Results The background of RA was as follows: age, 62.7±10.6 years; duration of disease, 14.5±11.8 years; low back pain assessed by VAS, 29.3±27.7 mm; DAS-28 ESR, 3.6±1.4. According to Steinbrocker’s criteria, the RA stages I, II, III and IV comprised 48, 62, 99 and 53 patients, respectively and 94, 127, 38 and 3 patientshad class 1, 2, 3 and 4 disease,respectively.The prevalence of lumbar lesions was 56.9% (DLS, LS and VF, 35.9%, 31.7% and 16.4% respectively). Each of RA class, DAS-ESR and VAS were significantly higher in the patients with, than without lumbar lesions (P=0.002, P=0.04, P<0.001, respectively).

Conclusions The reported prevalence of DLS, LS and VF among elderly Japanese is 17.4%, 8.9%, and 17.8% respectively¹⁾. Therefore, the prevalence of DLS and LS was considered to be higher in this study population. Erosion of endplate and/or facet joints might be the cause of the high prevalence of lumbar lesions. Patients with lumbar lesions had a significantly higher RA class and DAS-ESR, implying that the activity of RA might affect the incidence of lumbar lesions. Whether highly active RA or lumbar lesions cause low back pain remains unclear, but the higher prevalence of lumbar lesions in patients with RA also caused low back pain and reduced their quality of life (QOL).The class of RA, DAS-ESR and VAS were significantly higher in patients with lumbar lesions, and the prevalence of lesions was higher in patients with RA.

1. K Horikawa, Y Kasai, T Yamakawa, A Sudo, A Uchida. Prevalence of osteoarthritis, osteoporotic vertebral fractures, and spondylolisthesis among the elderly in a Japanese village. Journal of Orthopaedic Surgery 2006;14(1):9-12.

Disclosure of Interest H. Yasuda: None Declared, A. Suzuki: None Declared, T. Koike Grant/Research support from: Takeda Pharmaceutical,Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, H. Terai: None Declared, A. Matsumura: None Declared, H. Toyoda: None Declared, M. Tada: None Declared, S. Dohzono: None Declared, Y. Sugioka: None Declared, T. Okano: None Declared, K. Yamada: None Declared, S. Takahashi: None Declared, K. Tsukiyama: None Declared, Y. Shinohara: None Declared, A. Kamiyama: None Declared, H. Nakamura Grant/Research support from: Chugai Pharmaceutical, Astellas, Speakers Bureau: Ono