SAT0547 RADIOGRAPHIC IMAGING IN ASSESSMENT OF FLUOROSCOPIC GUIDED INJECTION OF RHEUMATOID ATLANTOAXIAL JOINT INFLAMMATION

Abstract

Background:Rheumatoid spondylitis is a feature of long-lasting Rheumatoid arthritis (RA) that is presented by neck pain, headache and sleep disturbance. Atlantoaxial joint (AAJ) is the commonest cervical spine joint that affected in patients with RA. When it is involved, it can be associated with dangerous complications. Magnetic Resonance Imaging (MRI) can be used for assessing the disease activity, the amount of cartilage destruction, associated cervical myelopathy and differentiating synovial fluid from inflammatory pannus (Taniguchi D, et al., 2008).Objectives:This study aimed to evaluate the efficacy of intra-articular steroid injection of inflamed AAJ in RA patients, regarding neck pain, headache and sleep quality using pre and post-interventions MRI.Methods:A prospective case control study. Patients with inflamed AAJ were recruited. Group 1 (AAJ group, n = 30), received intraarticular AAJ steroid injection, guided by fluoroscopy and Group 2 (control group, n = 30), received systemic steroids. Both groups were assessed with: Visual Analogue scale (VAS) for nocturnal neck pain and headache. Pittsburgh sleep quality index (PSQI) was used for sleep disturbance. Pre and post contrasts enhanced MRI interventions were done for both groups during the period of follow up (three months).Results:Nocturnal neck pain, headache and sleep disturbance have significantly decreased, during follow up visits (3 months), in AAJ group in comparison to the control group. The Pre-intervention nocturnal pain score was 60.3 ±17.1 in AAJ group & 58.5 ±17.9 in control group. Pain has significantly decreased after 2weeks in AAJ group with continuous improvement till 3 months’ post-intervention 6.9 ±4.65 & 51.26 ±10.54 respectively. The pre-intervention headache was 22.68 ±16.74 in AAJ group & 45.17 ±15.83 in control group decreased to 7.54 ±5.23 & 48.52 ±11.98 respectively post intervention. The percentage of patients who had sleep disturbance at baseline was 66.7% & 73.3% in AAJ and control groups respectively which has significantly decreased to 6.7% & 43.3% after 3 months. Regarding MRI, AAJ group hada statistical significant decreasein the percentage of patients with MRI synovial enhancement, inflammatorypannus,fibrosis and bone marrow edema in comparison to control group 3 months post intervention. All post-procedural side effects resolved within thmonth without further medical intervention, and no long-term sequelae were identifiedConclusion:Fluoroscopic guided intra-articular steroid injection of inflamed atlantoaxial joints is considered a beneficial therapeutic option in rheumatoid arthritis patients regarding clinical and radiological assessments.