Glucocorticoids and cervical spine deformity in RA: A 10-year longitudinal analysis

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Created On: 06/09/2025

Glucocorticoids are frequently prescribed to individuals with rheumatoid arthritis (RA), despite the well-established risks of long-term use, including osteoporosis and fracture susceptibility.

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Key take away

Long-term glucocorticoid use in early rheumatoid arthritis patients is directly associated with increased risk of cervical spine deformity over 10 years.

Background

Glucocorticoids are frequently prescribed to individuals with rheumatoid arthritis (RA), despite the well-established risks of long-term use, including osteoporosis and fracture susceptibility. However, their potential link to cervical spine deformities specific to RA remains unclear.

Therefore, this study sought to investigate the link between prolonged glucocorticoid use and RA-linked cervical spine deformity.

Method

Data from patients with newly diagnosed RA enrolled in the BeSt trial were analyzed to explore both the duration and cumulative dose of glucocorticoid therapy. Missing exposure data were addressed utilizing the last observation carried forward method. Cervical spine changes—namely atlantoaxial subluxation (AAS) and subaxial subluxation (SAS)—were evaluated via lateral radiographs taken at 5 and 10 years.

The link between glucocorticoid exposure and cervical spine abnormalities was assessed via multivariable logistic regression models, adjusting for age, gender, baseline Disease Activity Score (DAS), anti-citrullinated protein antibody (ACPA) status, and rheumatoid factor positivity. Mediation analysis was also carried out to check whether the mean DAS influenced the observed associations.

Result

Of the 272 volunteers, 108 (40%) exhibited cervical spine deformities (AAS and/or SAS > 2 mm). Each additional year of glucocorticoid therapy was linked to a heightened risk of cervical spine deformity, with an adjusted odds ratio (OR) of 1.19 (95% confidence interval [CI]: 1.03–1.38). Similarly, each additional gram of cumulative glucocorticoid dose corresponded to an OR of 1.06 (95% CI: 1.01–1.12). The mediation analysis did not indicate a meaningful role of mean DAS in these associations.

Conclusion

Prolonged glucocorticoid therapy in patients with early RA appears to be independently linked with the development of cervical spine deformities over a 10-year period. These findings support considering alternative treatments that successfully control disease activity while minimizing long-term structural impairment.