Abstract
BackgroundInvolvement of the cervical spine is common in patients with rheumatoid arthritis and can lead to devastating or even fatal consequences. Currently no guidelines exist as to whether radiographs of the cervical spine should be included in follow-up visits.ObjectivesTo determine whether the Simple Erosion Narrowing Score (SENS) of the hands correlate with the presence of cervical spine subluxation in patients with rheumatoid arthritis.MethodThis was a retrospective, observational, cross-sectional study. A total of 56 rheumatoid arthritis patients with hand radiographs and lateral radiographs of the cervical spine were evaluated. The SENS of the hands and the presence of cervical spine subluxation were compared. The SENS of the hands was correlated with the prevalence of cervical spine subluxation, as was the erosion and joint space narrowing scores of the hands.ResultsA correlation between the SENS of the hands and the prevalence of cervical spine subluxation was confirmed. A higher prevalence of cervical spine subluxation correlated with an increase in the SENS of the hands (p = 0.0002). The erosion and joint space narrowing scores of the hands also correlated with the prevalence of cervical spine subluxation (p = 0.0001).ConclusionThis study confirmed that a correlation exists between cervical spine subluxation, peripheral joint space erosions and joint space narrowing in patients with rheumatoid arthritis and SENS may therefore be used as a predictor of cervical spine disease.
Highlights
Rheumatoid arthritis (RA) is an autoimmune mediated disease characterised by chronic inflammation of synovial joints and involvement of the cervical spine.[1,2,3,4,5,6,7] The chronic inflammation of RA leads to damage in cartilage and subchondral bone which leads to joint destruction.[8,9] Cervical spine damage due to RA may give rise to myelopathy and sudden death due to spinal cord and brain stem compression.[10]
The Simple Erosion Narrowing Score (SENS) of the hands was determined on AP radiographs of the hands and the presence of cervical spine subluxation was determined on lateral radiographs of the cervical spine in the neutral, flexionand extension positions
The SENS of the hands was correlated with the prevalence of cervical spine subluxation to determine whether it can be used as a possible predictor of cervical spine subluxation
Summary
Rheumatoid arthritis (RA) is an autoimmune mediated disease characterised by chronic inflammation of synovial joints and involvement of the cervical spine.[1,2,3,4,5,6,7] The chronic inflammation of RA leads to damage in cartilage and subchondral bone which leads to joint destruction.[8,9] Cervical spine damage due to RA may give rise to myelopathy and sudden death due to spinal cord and brain stem compression.[10]. Atlantoaxial subluxation occurs as the result of an incompetent transverse ligament or erosion of the dens. It usually occurs in the anterior direction but may be in a posterior or lateral direction. Sub-axial subluxation is caused by facet joint erosion and ligament incompetence and can occur at multiple levels.[4,5,6]. No guidelines exist as to whether radiographs of the cervical spine should be included in follow-up visits
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