Abstract
IntroductionComplications in rheumatoid arthritis (RA) seem less common than they were years ago. The prevalence and progression of anterior atlantoaxial subluxations (aAASs), vertical subluxations (VSs), subaxial subluxations (SASs), and associated cervical myelopathy in RA over the past 50 years were determined.MethodsA literature search was performed by using Medline-OVID/EMBASE, PubMed, and Scopus (from 1960 to June 21, 2014). Prevalence studies were included if the sample size was at least 100 or the prevalence/progression of cervical subluxations was reported. Study quality was assessed by using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Prevalence of cervical subluxations was calculated for each study. Student’s t test and meta-regression were used to evaluate for significance.ResultsIn total, 12,249 citations were identified and 59 studies were included. The prevalence of aAAS decreased from 36% (95% confidence interval (CI) 30% to 42%) before the 1980s to 24% (95% CI 13% to 36%) in the 2000s (P = 0.04). The overall prevalence rates were 11% (95% CI 10% to 19%) for VS, 13% (95% CI 12% to 20%) for SAS, and 5% (95% CI 3% to 9%) for cervical myelopathy, and there were no significant temporal changes. Rates of progression of aAAS, VS, and SAS were 4, 6, and 3 lesions per 100 patients per year, respectively. The incidence of new or progressive cervical myelopathy was 2 cases per 100 patients with known cervical subluxations per year.ConclusionsSince the 1960s, only aAAS has decreased dramatically. It is still more than twice as common as VS or SAS. No temporal changes in the development of cervical myelopathy in affected patients with RA were noted. The progression rates of cervical subluxations and myelopathy were unchanged over time.
Highlights
Complications in rheumatoid arthritis (RA) seem less common than they were years ago
We looked for studies of cervical subluxations in patients with RA by using the following search strategy: 1. rheumatoid arthritis 2. cervical vertebrae 3. atlanto-axial joint 4. spinal diseases 5. joint instability 6
Eleven studies did not report on the rate or progression of cervical complications
Summary
Complications in rheumatoid arthritis (RA) seem less common than they were years ago. The prevalence and progression of anterior atlantoaxial subluxations (aAASs), vertical subluxations (VSs), subaxial subluxations (SASs), and associated cervical myelopathy in RA over the past 50 years were determined. Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that primarily affects the joints. Inflammatory arthritis of the small joints in the hands and feet is a common clinical manifestation, the cervical spine can be affected. E. Garrod reported 178 patients with cervical spine involvement in a series of 500 patients with RA [1]. Cervical spine involvement can take many forms. Reported findings include vertebral endplate erosions, spinous process erosions, and apophyseal joint changes, such as osteoporosis, blurring, and fusion [2,3]. The most characteristic lesions are subluxations [4,5]
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