Assessment of cervical spine involvement in rheumatoid arthritis patients in the era of biologics: a real-life, cross-sectional MRI study

Abstract

Cervical spine involvement may lead to severe complications in rheumatoid arthritis (RA). In the era of modern therapies, atlantoaxial subluxation (AAS) may be rare; however, it may still be detected in asymptomatic patients. The onset of myelopathy can occur at any time. Altogether 49 female RA patients were included. Among them, 15 were methotrexate treated, biologic free, while 34 patients received biologics. The patients had no cervical pain or any neurological symptoms. We assessed the first (C1) and second (C2) cervical vertebrae by 3 T magnetic resonance imaging (MRI). In addition to AAS, we also determined odontoid erosion or periodontal soft tissue thickening. We associated our MRI findings with clinical, laboratory parameters, and hand radiography. We detected anterior AAS and soft tissue thickening in one-quarter, while odontoid erosions in eight (16%) of RA patients. There were no significant differences among the therapeutic subgroups. No posterior or vertical AAS was seen. Anterior AAS was associated with higher degree of inflammation, soft tissue thickening was seen at younger age, while odontoid erosions were associated with van der Heijde–Sharp scores of the hand. None of the patients had any lesions requiring surgery. The presence of cervical involvement in RA patients with 10–11 years of disease duration is still an important and frequent phenomenon. Higher disease activity and erosive disease are associated with atlantoaxial involvement. 3 T MRI is a sensitive method to assess AAS, as well as soft tissue lesions and odontoid erosions.

Radiological Evaluation of Cervical Spine Involvement in Rheumatoid Arthritis: A Cross-Sectional Retrospective Study

“…The most serious complication of cervical spine arthritis is subluxations. Recent studies showed that anterior AAS was present in 18–32% of patients [ 8 , 12 , 13 ], whereas in our study, it was diagnosed in 58% of patients by radiographs, most likely because the study was conducted in a reference center for rheumatic diseases. Usually, AADI (anterior atlanto-dental interval) higher than 6 mm is considered for surgery [ 14 ].…”

“…In the current study, at the C1/C2 level, pannus was seen in 21% of patients, showing postcontrast enhancement in 5% of the patients, periodontal effusion in 11%, and BME in 5%. Another study showed similar results; the prevalence of pannus formation was almost 25% [ 13 ]. Carotti at al.…”

Imaging of cervical spine involvement in inflammatory arthropathies: a review

“…In approximately 20-70% of patients, C-spine lesions develop 10-11 years after disease onset, but in some individuals they may occur early and lead to instability. This condition, if untreated, may cause myelopathy with neurological deficits [ 2 ].…”

Predictors factors of atlanto‐axial subluxation in Tunisian patients with rheumatoid arthritis

“…Atlanto-axial subluxations, especially of the anterior type, are the most frequently encountered anomalies with an incidence varying between 18% and 32% of cases (Baek et al, 2021;Oláh et al, 2020;Yurube et al, 2012).…”