Rheumatoid Arthritis of Cervical Spine

Bland, John H.; Davis, Philip H.; London, Marshall G.; Buskirk, Frederick W. Van; Duarte, Cristobal G.

doi:10.1001/archinte.1963.03860060116013

Cited by 76 publications

(59 citation statements)

References 7 publications

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“…The most common characteristics of the cervical spine disorders in RA are horizontal and vertical subluxations of the atlantoaxial joint, i.e., anterior atlantoaxial subluxation (aAAS) and atlantoaxial impaction (AAI) (2). In addition, rheumatoid inflammation of the facet joints below the second cervical vertebra may result in subaxial subluxation (SAS), which can, however, be difficult to distinguish from subluxation caused by degeneration of the spine (3).…”

mentioning

confidence: 99%

Early and extensive erosiveness in peripheral joints predicts atlantoaxial subluxations in patients with rheumatoid arthritis

Neva¹,

Isomäki²,

Hannonen³

et al. 2003

Arthritis & Rheumatism

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Objective. To study the prevalence of cervical spine subluxations and predictive factors for atlantoaxial subluxations (including anterior atlantoaxial subluxation and atlantoaxial impaction, i.e., vertical subluxation) in patients with rheumatoid arthritis (RA) who were treated early and continuously with diseasemodifying antirheumatic drugs for 8-13 years.Methods. Radiographs of the cervical spine were obtained in 103 of 110 patients (the 110 surviving patients of the original 135-patient cohort) at their 8-13-year followup visits. The prevalence of cervical spine subluxations was determined. Demographic variables and the first 5-year serial data concerning disease course were analyzed in a logistic regression model to find predictive factors for atlantoaxial subluxations.Results. Atlantoaxial subluxations were found in 14 patients (14%), and 5 patients (5%) had subaxial subluxations. Older age at baseline, greater disease activity during the first 5 years, and early erosiveness in peripheral joints predicted the development of atlantoaxial subluxations. Patients who had >10% of the maximum possible radiographic damage (by Larsen score) in peripheral joints at 5 years were 15.9 times more likely to develop atlantoaxial subluxations at 8-13 years than patients whose peripheral joint damage remained <10% of the maximum.Conclusion. Compared with historical control RA cohorts, a lower prevalence of cervical spine destruction was found in the present group of patients. Rapid erosiveness in peripheral joints was the best predictor for atlantoaxial subluxations. Extensive erosiveness in peripheral joints should alert rheumatologists to the possible development of atlantoaxial subluxations in patients with RA.

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mentioning

confidence: 99%

Early and extensive erosiveness in peripheral joints predicts atlantoaxial subluxations in patients with rheumatoid arthritis

Neva¹,

Isomäki²,

Hannonen³

et al. 2003

Arthritis & Rheumatism

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“…Hence the risk of cord compression and the subsequent development of symptoms is greater (Bland 1974, Teigland & Magnaes 1980. Progressive spastic tetraplegia leading to death of the patient has been reported in connection with backward subluxation (Verjaal & Harder 1965).…”

Section: Discussion 'mentioning

confidence: 99%

Posterior atlanto-axial subluxation in rheumatoid arthritis

Santavirta

Sandelin

Slätis

1985

Acta Orthopaedica Scandinavica

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“…Most clinicians would agree that the answer to this lies in the precise neurological and radiological findings at time of presentation. The three principal agreed indications for surgical intervention in rheumatoid patients are spinal cord compression, debilitating pain, or significant dislocation on radiology imaging (King 1985, Bland 1990, Bouchaud & Liote 2002. Spinal cord compression may be noted on either clinical or radiological examination as detailed previously in this chapter.…”

Section: Indications For Surgical Interventionmentioning

confidence: 99%

“…Some authors have noted spontaneous radiological fusion occurring on serial follow up, but a significant proportion of these "auto-fused" patients will progress to displaying neurological deterioration. Though the timing of, and indications for, surgical intervention in such individuals remain controversial, many authors advocate decompression and arthrodesis, on the basis that the degree of neurological compromise often does not correlate with the degree of radiological subluxation (Rana et al 1973, Bland 1990, Oostveen et al 1999. Further, arthrodesis with the appropriate technique has been shown to prevent progression, particularly in relation to C1/C2 subluxation progressing to basilar invagination.…”

Section: Indications For Surgical Interventionmentioning

confidence: 99%