• Shintaro Honda, Koichi Murata, Bungo Otsuki, Takayoshi Shimizu, Takashi Sono, Soichiro Masuda, Koichiro Shima, Masaki Sakamoto, Takayuki Fujii, Akira Onishi, Kosaku Murakami, Hideo Onizawa, Masao Tanaka, Akio Morinobu, and Shuichi Matsuda.
• Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, Japan.
• Spine. 2025 Feb 15; 50 (4): 252258252-258.

Study DesignRetrospective cohort study.ObjectiveTo elucidate the factors related to the progression of scoliosis in patients with rheumatoid arthritis (RA) using longitudinal cohort data.BackgroundOf patients, 30% with RA have lumbar scoliosis. However, the effectiveness of current treatment methods in preventing the progression of scoliosis is not well understood due to a lack of longitudinal studies.Patients And MethodsWe enrolled 180 patients with RA who were followed up for over 2 years, all of whom underwent standing spinal x-rays. These patients were categorized based on their disease activity score-28 with erythrocyte sedimentation rate into 2 groups: (1) those in remission (n = 76) and (2) those in nonremission (n = 104). We evaluated various radiographic measures, including C7 center sacral vertical line, pelvic obliquity, major Cobb angle, and curve location.ResultsFifty-three (29.4%) patients presented progression of scoliosis during a mean follow-up period of 4.8 years. Patients in the nonremission showed larger Cobb angle at baseline and final follow-up, compared with those in remission. The annual progression rate of the curve was also greater in the nonremission group (1.04°/yr) than in the remission group (0.59°/yr, P = 0.001). There was no difference in the incidence of new vertebral fractures. The presence of a baseline Cobb angle of 10° or more [odds ratio (OR): 3.14; 95% CI: 1.38-7.13; P = 0.006], glucocorticoid use (OR: 2.88; 95% CI: 1.18-7.06; P = 0.021), and nonremission at baseline (OR: 2.83; 95% CI: 1.25-6.41; P = 0.012) were significant risk factors for progression of scoliosis.ConclusionRA disease activity is linked to the progression of scoliosis in patients with RA. Patients with RA who present with initial scoliosis of ≥10°, require glucocorticoids for treatment and are in nonremission at baseline may be at high risk for scoliosis progression.Level Of EvidenceLevel III.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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