Prevalence and Risk Factors of Anterior Atlantoaxial Subluxation in Ankylosing Spondylitis

Lee, Ji Seon; Lee, Seunghun; Bang, So-Young; Choi, Kwangseok; Joo, Kyung Bin; Kim, Yong Bum; Sung, Il Hoon; Kim, Tae‐Hwan

doi:10.3899/jrheum.120260

Cited by 23 publications

(10 citation statements)

References 28 publications

(38 reference statements)

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“…This is crucial and may include therapeutic implications, particularly because almost all of our patients needed treatment with biologic agents, including most of them requiring therapy intensification due to the diagnosis of cervical spine arthritis. This corroborates the findings of Lee who found that the use of TNF-α inhibitors was an independent risk factor of structural spinal damage [6]. Furthermore, our study shows that MRI specific findings like hyperintensities, enhancement and malalignments allow early diagnosis -as indicated by a median disease duration of 1.7 years after diagnosis of JIA - and that these changes often decrease under therapy while in some patients osseous changes increase.…”

Section: Discussionsupporting

confidence: 91%

Cervical spine involvement in patients with juvenile idiopathic arthritis - MRI follow-up study

et al. 2014

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BackgroundTo describe MRI and clinical findings in patients with juvenile idiopathic arthritis with cervical spine involvement at onset and follow-up under therapy.Methods13 patients with signs of cervical spine involvement in juvenile idiopathic arthritis with a median disease duration of 1.7 years were included in the study. Clinical records and MR images were retrospectively analyzed according to symptoms and findings concerning the cervical spine.ResultsAt the onset of cervical spine involvement all patients showed limited range of motion, whereas only 5 of them complained of pain. In MR images joint hyperintensity, contrast enhancement, malalignment, ankylosis, erosion and narrowing of the spinal canal at cranio-cervical junction were found at 28, 32, 15, 2, 2 and 3 sites in 12 (93%), 13 (100%), 8 (62%), 2 (15%), 2 and 3 (20%) patients respectively. 3 of the 5 patients with pain (60%) showed ankylosis, erosions or narrowing of the spinal canal at cranio-cervical junction on MRI. At follow-up - after a median disease duration of cervical spine arthritis of 2.1 years and a variable duration of treatment with methotrexate (all patients) and biological agents (12 patients) - joint hyperintensity, enhancement and malalignment decreased to 15, 19 and 6 sites in 10 (77%), 11 (85%) and 3 (20%) patients respectively whereas ankylosis, erosion and narrowing of the spinal canal at cranio-cervical junction increased to 7, 6 and 4 sites in 3 (20%), 4 (31%) and 4 patients respectively. Pain was no longer reported, but 9 of 13 (69%) patients still had a limited range of motion with 6 of them (46%) showing skeletal changes on MRI.ConclusionsThis first MRI based follow-up study shows that cervical spine arthritis can follow a severe disease course in juvenile arthritis. While malalignments and inflammation sites decreased osseous changes with erosions, ankylosis, and narrowing of the spinal canal increased under treatment despite only minor subjective complaints. Therefore close MRI monitoring of these patients appears to be reasonable.

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Section: Discussionsupporting

confidence: 91%

Cervical spine involvement in patients with juvenile idiopathic arthritis - MRI follow-up study

et al. 2014

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“…Changes in one or more elements of the CCJ were detected in all 11 patients enrolled, with wide spectrum of both joint and ligamentous involvement seen. Previous studies, based on the conventional radiography, had reported changes in the atlantodental articulation, such as fusion and subluxation, as the most frequent forms of CCJ involvement by AS [9,10]. Pathologic alterations of atlanto-occipital joints and ligaments had been only rarely mentioned in the literature [11,12].…”

Section: Discussionmentioning

confidence: 98%

Craniocervical junction involvement in ankylosing spondylitis

et al. 2015

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“…23 Duration of the disease is the major factor that determines atlantoaxial subluxation, but it is also associated with the presence of peripheral arthritis. 32 One possible explanation is that chronic systemic inflammation in these patients may lead to chronic synovitis resulting in bony erosion and ligamentous laxity that may result in instability. 33 Other causes of atlantoaxial subluxation may be sequelae of ossification of the anterior and posterior longitudinal ligaments and physical stresses (kyphosis of the dorsa spine and weight of the head at the C1–C2 level).…”

Section: Introductionmentioning

confidence: 99%

Comorbid pain in axial spondyloarthritis, including fibromyalgia

López-Medina

Moltó

2020

Therapeutic Advances in Musculoskeletal

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The main symptom in patients with axial spondyloarthritis (axSpA) is inflammatory back pain, caused principally by inflammation of the sacroiliac joints and the spine. However, not all back pain in patients with axSpA is related to active inflammation: other types of pain can occur in these patients, and may be related to structural damage (e.g. ankylosis), degenerative changes, vertebral fractures or comorbid fibromyalgia, which are not uncommon in these patients. Structural damage and ankylosis may lead to a biomechanical stress, which can lead to chronic mechanical pain; and degenerative changes of the spine may also exist in patients with axSpA also leading to mechanical pain. Osteoporosis is more prevalent in axSpA patients than in the general population, and vertebral fractures may result in acute bone pain, which can persist for several months. Fibromyalgia, which is also more prevalent in patients with chronic inflammatory diseases (including axSpA), presents with widespread pain which can mimic entheseal pain. A correct diagnosis of the origin of the pain is crucial, since treatments and management may differ considerably. Recognizing these causes of pain may be a challenge in clinical practice, especially for fibromyalgia, which can coexist with axSpA and may have a significant impact on biologic drug response. In this review, we provide an update of the most common causes of pain other than inflammatory back pain in axSpA patients, and we discuss the latest management options for such causes.

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Prevalence and Risk Factors of Anterior Atlantoaxial Subluxation in Ankylosing Spondylitis

Cited by 23 publications

References 28 publications

Cervical spine involvement in patients with juvenile idiopathic arthritis - MRI follow-up study

Cervical spine involvement in patients with juvenile idiopathic arthritis - MRI follow-up study

Craniocervical junction involvement in ankylosing spondylitis

Comorbid pain in axial spondyloarthritis, including fibromyalgia

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