Neurologic dysfunction in patients with rheumatoid arthritis of the cervical spine. Predictive value of clinical, radiographic and MR imaging parameters

Abstract

The aim of this study was to evaluate if subjective symptoms, radiographic and especially MR parameters of cervical spine involvement, can predict neurologic dysfunction in patients with severe rheumatoid arthritis (RA). Sequential radiographs, MR imaging, and neurologic examination were performed yearly in 46 consecutive RA patients with symptoms indicative of cervical spine involvement. Radiographic parameters were erosions of the dens or intervertebral joints, disc-space narrowing, horizontal and vertical atlantoaxial subluxation, subluxations below C2, and the diameter of the spinal canal. The MR features evaluated were presence of dens and atlas erosion, brainstem compression, subarachnoid space encroachment, pannus around the dens, abnormal fat body caudal to the clivus, cervicomedullary angle, and distance of the dens to the line of McRae. Muscle weakness was associated with a tenfold increased risk of neurologic dysfunction. Radiographic parameters were not associated. On MR images atlas erosion and a decreased distance of the dens to the line of McRae showed a fivefold increased risk of neurologic dysfunction. Subarachnoid space encroachment was associated with a 12-fold increased risk. Rheumatoid arthritis patients with muscle weakness and subarachnoid space encroachment of the entire cervical spine have a highly increased risk of developing neurologic dysfunction.

EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis

“…Thirteen studies described the assessment of cervical spine involvement in RA, summarised in table 4 108 – 120. No studies explored the appropriate frequency for monitoring change in the cervical spine; Yurube et al 118 investigated baseline features on CR predictive of future cervical instability and found that patients with baseline deforming hand changes, cervical vertical subluxation (VS), and subaxial subluxation showed more progression in VS and subaxial subluxation at 5 years, and Reijnierse et al 120 identified that baseline MRI atlas erosions and reduced subarachnoid space were associated with clinical neurological dysfunction at 1 year.…”

Contrast-enhanced MR imaging with fat suppression in adult-onset septic spondylodiscitis

“…Rheumatoid arthritis, for example, usually involves the cranio-cervical junction, even though recent studies report that the appearance of neurological signs in patients with rheumatoid arthritis may be secondary to alterations at a lower level, such as encroachment of the subaracnoid space between C1 and C7 [52].…”

The Kinematic Relationships of the Upper Cervical Spine

“…Numerous experimental studies using plain radiography, computed tomography, and MRI have reported the pathogenesis and biomechanics of the upper cervical spine in patients with rheumatoid arthritis (RA) or trauma. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] However, to the best of our knowledge, there are few reports on the kinematic relationships of the occipitoatlantoaxial complex in non-RA or nontraumatic patients using dynamic MR images, and many points on these kinematics relationships remain to be clarified. The objective of this study is to elucidate the kinematic relationships of the upper cervical spine in patients with general age-related cervical spondylosis with Kinetic MRI (K-MRI).…”