Evaluation of the Cervical Spine Among Patients With Rheumatoid Arthritis

Abstract

Objective: To evaluate the prevalence of cervical spine abnormalities among patients with rheumatoid arthritis and correlate the imaging findings with the clinical state. Methods: A cross-sectional study on 35 patients was carried out at the School of Medicine of the Federal University of Goiás (UFG) in 2004. The following were evaluated: age, use of medications and the clinical picture of pain and neurological characteristics. The erythrocyte sedimentation rate (ESR) and rheumatoid factor were tested, and radiographs of the cervical spine were produced in anteroposterior, lateral and dynamic views. To evaluate the influence of the variables on the emergence of instabilities, univariate and multivariate logistic regression tests were used (p < 0.05). Results: Among the 35 patients evaluated, 13 (37.1%) presented a stable cervical spine. Out of the 22 patients with instability, six presented more than one type. Atlantoaxial instability was found in 15 patients, with a mean anterior atlantodental distance of 3.40 mm in the neutral lateral radiographic view and 6.54 mm in the lateral view with flexion. Basilar invagination was found in five patients and subaxial subluxation in seven patients. Two thirds of the asymptomatic patients had instabilities. Bicipital hyperreflexia presented statistically significant correlations with atlantoaxial instability (p = 0.024) and subaxial instability (p = 0.01). Age at diagnosis correlated with subaxial instability (p = 0.02). Conclusions: The prevalence of cervical instability was 62.9 % (22/35). The most frequent instabilities were: atlantoaxial subluxation (42.9 %), subaxial subluxation (20%) and basilar invagination (14.3%). The correlation between instabilities and clinical signs and symptoms was poor. The patients with subaxial subluxation presented disease onset at a younger age. Dynamic radiography was important for diagnosing atlantoaxial subluxation.

Investigating the prevalence of cervical spine instability in patients with rheumatoid arthritis

“…In the study conducted by Al-daoseri et al, 7.4% of the studied patients had instability of the cervical spine, of which 73.3% was AAS [14]. In the study conducted by André Luiz et al, atlantoaxial subluxation was present in 42.9% of the studied patients [18]. In the study conducted by Baek et al, among 1114 rheumatoid arthritis patients examined, 306 cases (27.5%) had cervical spine instability, and the most common type is atlantoaxial subluxation with 17.9% [19].…”

Cervical spine instability in the course of rheumatoid arthritis – imaging methods

“…Cranial settling (CrS) is another pathology of cervical spine that occurs in patients with RA and is described in ca. 15% of patients [ 3 , 8 ]. Definitions of the respective types of cervical spine instability are presented in Table I .…”