Effect of combination drug therapy on rheumatoid atlantoxial subluxations

Aggressive combination-DMARD therapy with sulfasalazine, methotrexate, hydroxychloroquine, and prednisolone appears to prevent or retard the development of rheumatoid atlantoaxial disorders.

One hundred ninety-five patients with recent-onset RA (mean disease duration 8 months) were randomly assigned to receive a combination of DMARDs (sulfasalazine, methotrexate, hydroxychloroquine, and prednisolone) or a single DMARD with or without prednisolone . After 2 years of followup, cervical spine radiographs were taken of 176 of these patients (85 in the combination-therapy group and 91 in the single-therapy group). Anterior atlantoaxial subluxation (aAAS), atlantoaxial impaction (AAI; i.e., vertical subluxation), and subaxial subluxation (SAS) were found in only 6 (3.4 %), 2 (1.1 %), and 5 (2.8 %) of the patients, respectively. None of the patients in the combination-therapy group had aAAS or AAI. The incidences of aAAS and AAI in the single-therapy group were 6.6 % and 2.2 %, respectively. SAS was present in 2 patients (2.2 %) in the single-therapy group and in 3 patients (3.5 %) in the combination-therapy group. The difference in the incidence of aAAS between the treatment groups was statistically significant (P = 0.029).

Comment: The quality of evidence is downgraded by imprecise results (limited study size).

Ədəbiyyat

1. Neva MH, Kauppi MJ, Kautiainen H, Luukkainen R, Hannonen P, Leirisalo-Repo M, Nissilä M, Möttönen T, FIN-RACo Trail Group. Combination drug therapy retards the development of rheumatoid atlantoaxial subluxations. Arthritis Rheum 2000 Nov;43(11):2397-401.