Prolonged Steroid Use in RA tied to Spine Complications,Warns New Study

Researchers found that each additional year of glucocorticoid use increased the risk by 19% (OR 1.19), while every 1-gram rise in cumulative dose raised the risk by 6% (OR 1.06). The findings reinforce the need to consider alternative therapies to reduce long-term skeletal complications.

The researchers note that glucocorticoids have long been a cornerstone in the treatment of RA, especially in early or severe cases, due to their fast-acting anti-inflammatory benefits. However, they are also known to carry significant risks when used long-term, including osteoporosis, fractures, muscle weakness, and increased susceptibility to infections. Despite these concerns, they continue to be widely prescribed for RA patients.

Given these potential complications, Anna B. Lebouille-Veldman, Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands, and colleagues conducted a study to examine the relationship between the dose and duration of glucocorticoid use and the risk of cervical spine deformity over a 10-year follow-up in patients with newly diagnosed RA.

For this purpose, the researchers assessed the duration and dose of glucocorticoid use in patients with newly diagnosed RA from the BeSt Trial. Missing data on medication use were handled using the last observation carried forward method. Cervical spine X-rays taken at 5 and 10 years were examined for signs of atlantoaxial and subaxial subluxation. To understand the link between glucocorticoid use and cervical spine deformity, the team used multiple logistic regression, adjusting for factors such as age, gender, baseline disease activity, and antibody status. They also performed a mediation analysis to explore if disease activity played a role in this association.

The study led to the following findings:

• Cervical spine deformity (atlantoaxial and/or subaxial subluxation >2 mm) was found in 108 out of 272 patients (40%).
• Each additional year of glucocorticoid use was associated with a 19% increased risk of cervical deformity (adjusted OR 1.19).
• Every 1-gram increase in cumulative glucocorticoid dose raised the risk by 6% (adjusted OR 1.06).
• Mediation analysis showed that the mean Disease Activity Score (DAS) did not influence the observed associations.

The authors concluded that long-term use of glucocorticoids in newly diagnosed rheumatoid arthritis (RA) patients was directly associated with an increased risk of cervical spine deformity over 10 years. They found that patients who developed cervical deformities had received higher cumulative doses and longer durations of glucocorticoid therapy compared to those without such deformities.

Their analysis revealed that even a one-year increase in glucocorticoid use or a one-gram rise in cumulative dose significantly elevated the risk. While acknowledging the benefits of glucocorticoids in controlling disease activity, the authors emphasized the need for caution in their prolonged use, particularly in patients at higher risk of spinal complications. They suggested alternative therapies, such as biological DMARDs, may be more suitable for long-term management.

The authors also called for future research to identify predictive factors for cervical spine deformity in RA, which could guide early intervention and safer treatment decisions.

Reference:

Lebouille-Veldman, A.B., Huizinga, T.W.J., Mekary, R.A. et al. Prolonged glucocorticoid use and rheumatoid arthritis-associated cervical spine deformity. Clin Rheumatol (2025). https://doi.org/10.1007/s10067-025-07408-w