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

Csaba Oláh,Zsófia Kardos,László Tamási,Katalin Hodosi,László Kostyál,Zoltán Szekanecz,Dániel Bereczki

doi:10.1007/s00296-020-04549-w

Abstract

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.

Highlights

Rheumatoid arthritis (RA) is a chronic inflammatory rheumatic disease often involving the small joints of the hands and feet, the wrists, elbows, ankles, and knees [1]
Chronic inflammation associated with RA may cause chronic synovitis, erosive pannus leading to odontoid erosion, laxity of ligaments, spinal instability, and subluxation in the atlantoaxial joint (AAS) [2, 4]
Vertical atlantoaxial subluxation (AAS) is the consequence of vertebral destruction and may even cause cranial settling with basal invagination [2,3,4, 7]

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic inflammatory rheumatic disease often involving the small joints of the hands and feet, the wrists, elbows, ankles, and knees [1]. The atlantooccipital and atlantoaxial joints are the only vertebral segments without intervertebral disk. These sections of the cervical spine are mostly affected by RA [6]. Chronic inflammation associated with RA may cause chronic synovitis, erosive pannus leading to odontoid erosion, laxity of ligaments, spinal instability, and subluxation in the atlantoaxial joint (AAS) [2, 4]. AAS can be anterior, posterior or vertical. Vertical AAS is the consequence of vertebral destruction and may even cause cranial settling with basal invagination [2,3,4, 7]

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Results

Conclusion