Abstract
Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that impacts on weakening ligaments, synovial arthritis and cartilage damage. The effect that can occur is instability and neural compression in the upper and sub-axial cervical. The prevalence of atlantoaxial instability (AAI) is around 40-80% among rheumatoid patients, but it is interesting to examine the clinical symptoms that are not so visible despite radiological instability confirmed on the cervical spine. However, once the clinical symptoms of myelopathy occur, the mortality rate will increase sharply.
 We report a case of a 66-years old female who was admitted to our hospital with gait disturbance and weakness of her lower extremities. Radiographic evaluation of the cervical spine showed erosive destruction of the odontoid process of C2, anterior atlantoaxial subluxation, and thickened yellow ligaments from C3 to C7. Surgery was performed by removal of the posterior arch of C1 and laminectomy C3 to C7, posterior occipito-cervical screw fixation from C3 to C7, combined with atlantoaxial transpedicular screw fixation. A sterno sub-occipitomandibular immobilization (SOMI) orthosis was applied for postoperative immobilization for 12 weeks. Improvement of motoric status noted after surgery.
Highlights
Rheumatoid arthritis (RA) is a chronic inflammatory process that causes symmetrical synovitis, resulting in deformities in the hands and feet’s small joints.[1]
We report a case of a 66-years old female who was admitted to our hospital with gait disturbance and weakness of her lower extremities
Biological therapy such as 17 infliximab (IFX) as first-line biologic treatment and 17 tocilizumab (TCZ) as a second-line biologic treatment combined with methotrexate (MTX) on rheumatoid arthritis can decrease cervical involvement to 15-30%
Summary
Rheumatoid arthritis (RA) is a chronic inflammatory process that causes symmetrical synovitis, resulting in deformities in the hands and feet’s small joints.[1]. The risk of irreversible paralysis is increased if the posterior atlanto-dental interval (PADI) is 14 mm or less.[5] Neural compression may progress and cause death in 10% of patients with cervical rheumatoid arthritis in post mortem studies.[11] Essential discussions have existed about the management in patients whom radiologically confirmed cervical instability in the absence or mild neck pain and neurological symptoms.[12] To avoid unnecessary surgery, some of the authors accept conservative management, cervical orthosis, and symptomatic treatment. She experienced gradual improvements in motoric status after the surgery
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