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- Robinson, Yohan, 1977-, et al.
(författare)
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Do biological disease-modifying antirheumatic drugs reduce the spinal fracture risk related to ankylosing spondylitis? : A longitudinal multiregistry matched cohort study
- 2017
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Ingår i: BMJ Open. - London, UK : BMJ Publishing Group Ltd. - 2044-6055. ; 7:12
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Ankylosing spondylitis (AS) is associated with an increased spinal fracture risk due to the loss of elasticity in spinal motion segments. With the introduction of biological disease-modifying antirheumatic drug (bDMARD) treatment for AS, the individual course of the disease has been ameliorated. This study aims to examine the association of bDMARD treatment and risk of spinal fracture.Design: Longitudinal population-based multiregistry observational matched cohort study.Setting: Swedish Patient Registry 1987-2014 and Swedish Prescribed Drugs Registry 2005-2014.Participants: Included were patients ≥18 years of age receiving treatment at a healthcare facility for the primary diagnosis of AS. About 1352 patients received more than one prescription of bDMARD from 2005 to 2014. An untreated control group was created by propensity score matching for age, sex, comorbidity, antirheumatic prescriptions and years with AS (n=1352).Main Outcome Measures: Spinal fracture-free survival.Results: No bDMARD treatment-related effect on spinal fracture-free survival was observed in the matched cohorts. Male gender (HR=2.54, 95% CI 1.48 to 4.36) and Charlson Comorbidity Index score (HR=3.02, 95% CI 1.59 to 5.75) contributed significantly to spinal fracture risk.Conclusion: bDMARD had no medium-term effect on the spinal fracture-free survival in patients with AS.Trial Registration Number: NCT02840695
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| 2. |
- Robinson, Yohan, 1977-, et al.
(författare)
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Surgical Stabilization Improves Survival of Spinal Fractures Related to Ankylosing Spondylitis
- 2015
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 40:21, s. 1697-1702
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. National registry cohort study. Objective. The aim of this study was to investigate the effect of surgical stabilization on survival of spinal fractures related to ankylosing spondylitis (AS). Summary of Background Data. Spinal fractures related to AS are associated with considerable morbidity and mortality. Multiple studies suggest a beneficial effect of surgical stabilization in these patients. Methods. In the Swedish patient registry, all patients treated in an inpatient facility are registered with diagnosis and treatment codes. The Swedish mortality registry collects date and cause of death for all fatalities. Registry extracts of all patients with AS and spinal fractures including date of death and treatment were prepared and analyzed for epidemiological purposes. Results. Seventeen thousand two hundred ninety-seven individual patients with AS were admitted to treatment facilities in Sweden between 1987 and 2011. Nine hundred ninety patients with AS (age 66 +/- 14 years) had 1131 spinal fractures, of which 534 affected cervical, 352 thoracic, and 245 lumbar vertebrae. Thirteen percent had multiple levels of injuries during the observed period. Surgically treated patients had a greater survival than those treated nonsurgically [hazard ratio (HR) 0.79, P = 0.029]. Spinal cord injury was the major factor contributing to mortality in this cohort (HR 1.55, P< 0.001). The proportion of surgically treated spinal fractures increased linearly during the last decades (r = 0.92, P< 0.001) and was 64% throughout the observed years. Conclusions. Spinal cord injury threatened the survival of patients with spinal fractures related to AS. Even though surgical treatment is associated with a considerable complication rate, it improved the survival of spinal fractures related to AS.
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