The Craniovertebral Junction in Rheumatoid Arthritis: State of the Art

Ferrante, A; Ciccia, Francesco; Giammalva, Giuseppe Roberto; Iacopino, Domenico Gerardo; Visocchi, Massimiliano; Macaluso, Federica; Maugeri, Rosario

doi:10.1007/978-3-319-62515-7_12

Cited by 12 publications

(11 citation statements)

References 56 publications

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“…Isolated, mostly anterior AAS may develop early in the disease course and it can later be complicated with soft tissue involvement and odontoid erosions. Myelopathy may occur at any time initially leading to headache and neck pain, followed by more advanced neurological symptoms [8][9][10][11]14]. As 3 T MRI instruments have only recently become available, we wished to try this technique to assess cervical spine pathology in RA.…”

Section: Discussionmentioning

confidence: 99%

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

Oláh¹,

Kardos²,

Kostyál

et al. 2020

Rheumatol Int

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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.

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Section: Discussionmentioning

confidence: 99%

“…Neurological signs may not be present up to 10 mm of AAS [8]. Suboccipital pain may be the first symptom of AAS [9]; however, it may be absent in more than half of patients with known instability [10]. Dizziness, tinnitus, and dysphagia may also occur [8,10].…”

Section: Introductionmentioning

confidence: 99%

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

Oláh¹,

Kardos²,

Kostyál

et al. 2020

Rheumatol Int

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“…Recent studies (6,29,30) have examined the relationship between RA and AAS. However, the current evidence is limited to observational studies, and the results may be influenced by confounding factors.…”

Section: Discussionmentioning

confidence: 99%

Genetically predicted C-reactive protein mediates the association between rheumatoid arthritis and atlantoaxial subluxation

et al. 2022

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ObjectiveInvestigating the causal relationship between rheumatoid arthritis (RA) and atlantoaxial subluxation (AAS) and identifying and quantifying the role of C-reactive protein (CRP) as a potential mediator.MethodsUsing summary-level data from a genome-wide association study (GWAS), a two-sample Mendelian randomization (MR) analysis of genetically predicted rheumatoid arthritis (14,361 cases, and 43,923 controls) and AAS (141 cases, 227,388 controls) was performed. Furthermore, we used two-step MR to quantitate the proportion of the effect of c-reactive protein-mediated RA on AAS.ResultsMR analysis identified higher genetically predicted rheumatoid arthritis (primary MR analysis odds ratio (OR) 0.61/SD increase, 95% confidence interval (CI) 1.36-1.90) increased risk of AAS. There was no strong evidence that genetically predicted AAS had an effect on rheumatoid arthritis risk (OR 1.001, 95% CI 0.97-1.03). The proportion of genetically predicted rheumatoid arthritis mediated by C-reactive protein was 3.7% (95%CI 0.1%−7.3%).ConclusionIn conclusion, our study identified a causal relationship between RA and AAS, with a small proportion of the effect mediated by CRP, but a majority of the effect of RA on AAS remains unclear. Further research is needed on additional risk factors as potential mediators. In clinical practice, lesions of the upper cervical spine in RA patients need to be given more attention.

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“…It has been well reported by many researchers that the retro-odontoid mass tissue disappeared after fixation of the CVJ. 14,17,18,25 Chang et al 17 observed that the TA decreased immediately after the surgery and continued to decrease until 2 years after surgery. In this study, the ΔTA was 1.18 cm 2 in patients who had combined anterior and posterior decompression surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The deformed CVJ could cause significant neck pain due to arthritis or C2 foraminal stenosis and cervicomedullary compressive myelopathy. [11][12][13][14] There have been numerous diagnostic criteria for CVJ disease. However, most of the current radiographic parameters are…”

Section: Introductionmentioning

confidence: 99%

Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy

Chang

et al. 2022

Neurospine

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Objective: Diseases of the craniovertebral junction (CVJ) are commonly associated with deformity, malalignment, and subsequent myelopathy. The misaligned CVJ might cause compression of neuronal tissues and subsequently clinical symptoms. The triangular area (TA), measured by magnetic resonance imaging/images (MRI/s), is a novel measurement for quantification of the severity of compression to the brain stem. This study aimed to assess the normal and pathological values of TA by a comparison of patients with CVJ disease to age- and sex-matched controls. Moreover, postoperative TAs were correlated with outcomes.Methods: Consecutive patients who underwent surgery for CVJ disease were included for comparison to an age- and sex-matched cohort of normal CVJ persons as controls. The demographics, perioperative information, and pre- and postoperative 2-year cervical MRIs were collected for analysis. Cervical TAs were measured and compared.Results: A total of 201 patients, all of whom had pre- or postoperative MRI, were analyzed. The TA of the CVJ deformity group was larger than the healthy control group (1.62 ± 0.57 cm2 vs. 1.01 ± 0.18 cm2, p < 0.001). Moreover, patients who had combined anterior odontoidectomy and posterior laminectomy with fixation had the greatest reduction in the TA (1.18 ± 0.58 cm2).Conclusion: In CVJ deformity, the measurement of the cervical TA could indicate the severity of brain stem compression. After surgery, the TA had a varying degree of improvement, which could represent the efficacy of surgery.

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The Craniovertebral Junction in Rheumatoid Arthritis: State of the Art

Cited by 12 publications

References 56 publications

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

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

Genetically predicted C-reactive protein mediates the association between rheumatoid arthritis and atlantoaxial subluxation

Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy

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