Radiological Evaluation of Cervical Spine Involvement in Rheumatoid Arthritis: A Cross-Sectional Retrospective Study.

Mateusz Kotecki,Robert Gasik,Iwona Sudoł-Szopińska,Piotr Głuszko

doi:10.3390/jcm10194587

Abstract

Background: Cervical spine lesions are a common manifestation of rheumatoid arthritis (RA). The purpose of this study was to conduct a retrospective analysis of radiological lesions in cervical spine in patients with RA and to correlate findings with clinical and laboratory parameters. Methods: Overall, 240 consecutive patients with RA were referred for imaging by clinicians based on symptoms suggesting cervical spine involvement and/or long disease duration. In each patient, lateral radiographs and MRI of the cervical spine were performed. The imaging data were correlated with clinical records and laboratory data. Results: The cervical spine was affected in 179 patients (75%). The most common lesions were anterior atlanto-axial subluxation (AAS; 58%), subaxial subluxation (58%), and demineralization (48%). Cervical spine involvement was linked to longer disease duration (p = 0.007), the presence of rheumatoid factor (RF; p = 0.010), elevated C-reactive protein (CRP) levels (p = 0.016), and accelerated erythrocyte sedimentation rate (ESR; p = 0.025). Longer disease duration was associated with anterior AAS (p = 0.005), subaxial subluxation (p = 0.005), and basilar settling (p = 0.003). Conclusions: As many as 75% of RA patients develop lesions that can be observed on radiographs and through MRI. The most frequent radiological findings include anterior AAS and subaxial subluxation. Long disease duration, RF seropositivity, and elevated inflammatory markers were risk factors for cervical spine involvement.

Highlights

Rheumatoid arthritis (RA) is an immune-mediated inflammatory disease affecting numerous joints of the peripheral and axial skeleton
Recent studies showed that anterior axial subluxation (AAS) was present in 18–32% of patients [8,12,13], whereas in our study, it was diagnosed in 58% of patients by radiographs, most likely because the study was conducted in a reference center for rheumatic diseases
The current study showed that functional projections detected 62% of all anterior AAS, which were not seen in the neutral position

Summary

Introduction

Rheumatoid arthritis (RA) is an immune-mediated inflammatory disease affecting numerous joints of the peripheral and axial skeleton. Cervical spine involvement is the third most common manifestation of RA after hands and feet and may develop in 17–88%. Atlanto-axial level is the most frequent cervical spine location of RA with possible life-threating complications. Chronic inflammation at the C1/C2 joint may lead to the progressive destruction of bones and ligaments causing subluxations [1], with further cervical spine compression and even sudden death [2]. The main risk factors for cervical spine involvement in RA include early onset of RA, advanced disease in peripheral joints, presence of rheumatoid factor (RF), and chronic use of corticosteroids [3,4]

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