Cervical Spine In Rheumatoid Arthritis Research Articles

Update on imaging of the cervical spine in rheumatoid arthritis.

Rheumatoid arthritis is a multisystem, autoimmune, inflammatory disorder with numerous musculoskeletal manifestations. Involvement of the cervical spine is common and may result in severe complications due to synovitis, erosions, pannus formation, spinal instability and ankylosis. The purpose of this article is to review the current role of imaging in the rheumatoid spine, with emphasis on radiographs and MRI.

Prevalence of Neck Dysfunction in Women Using High Heeled Footwear Working in I.T. Profession

Background: Nowadays, high heels are very commonly used in all age groups. And in some of the I.T companies it is compulsory to wear high heels for min 8 hours per day. Therefore, its negative impact seen on women health. While wearing high heels it is difficult to maintain the balance and Center of Gravity. Therefore, postural changes seen in women during standing and walking there is increase lumbar lordosis to compensate that there is increase in cervical lordosis. These change in spinal curvature will result into the neck dysfunction. Objective: To find out prevalence of neck dysfunction in women using high heeled footwear working in IT profession. Methodology: An observational study was carried out using a cross sectional study design. The study was conducted in the in and around Karad, Maharashtra. Study was conducted using sample size of 95 [ n- 4pq/ L2 ] using high heeled footwear working in IT companies for period of 6 months. The inclusion criteria were age group 20-35 years using high heels regularly for more than 8 hours and height of footwear more than 5 cm. and exclusion criteria was women underwent recent spine surgery including cervical, thoracic or lumbar spine, any congenital deformity of spine. Any recent trauma to spine, musculoskeletal deformity e.g. Rheumatoid arthritis of cervical spine or osteoarthritic condition. Result: The women those are wearing high heeled footwear for more than 8 hours/day with height of footwear >5cm suffering from mild to moderate neck disability and it is significantly seen in age group of 25-35 years. Conclusion: From this study, it can be concluded that the women wearing high heels footwear for more than 8 hours/day suffering from mild to moderate neck dysfunction

Radiological Findings of the Cervical Spine in Rheumatoid Arthritis: What a Rheumatologist Should Know.

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting mainly the peripheral skeleton in a symmetrical manner rather than the axial skeleton, but when it occurs it can affect the cervical spine (CS). Although CS involvement is a frequent radiographic finding in RA, the clinical features are scarce, but potentially life-threatening with severe neurological deficits or even death due to brain stem compression. The commonest site of inflammation of the CS is the articulation between C1 and C2 vertebrae, the atlanto-axial region. The radiological finding observed in this region is the atlanto-axial subluxation (AAS). For the evaluation of CS in RA the classical diagnostic technique used mostly is conventional radiography (CR). Since CR does not provide good information regarding synovial inflammation, other imaging modalities are used such as magnetic resonance imaging and computed tomography. However, CR is the most valuable tool for screening CS in RA patients. Thus, we reviewed the literature until December 2019 for studies regarding CS radiological manifestations using CR in RA patients. We found that the frequency of radiological findings varies substantially, ranging between 0.7-95% in different studies. The commonest radiological feature was the AAS followed by subaxial subluxation. Because CS involvement can often be clinically asymptomatic, its assessment should not be forgotten by physicians and should be assessed using CR which is an easy to perform technique and gives important information as a screening tool.

Bony ankylosis of the facet joint of the cervical spine in rheumatoid arthritis: Its characteristics and relationship to the clinical findings

Objectives: The purpose of this study was to clarify the characteristics of bony ankylosis of the facet joint of the cervical spine in rheumatoid arthritis (RA) patients who required cervical spine surgery, and its relationship to the clinical findings.Methods: Eighty consecutive RA patients with cervical spine disorder who received initial surgery were reviewed. The occurrence of bony ankylosis of the facet joint of the cervical spine was investigated using computed tomography (CT) before surgery. We also evaluated the severity of neurological symptoms and the plain wrist radiographs taken before surgery; furthermore, we evaluated each patient’s medical history for total knee arthroplasty (TKA) or hip arthroplasty (THA).Results: The preoperative CT imaging demonstrated bony ankylosis of the facet joint of the cervical spine in 45 facet levels of 19 cases (BA + group). In all patients, responsible instability or stenosis was demonstrated just caudal or on the cranial side of those bony ankylosis. Before surgery, the BA + group included significantly more patients showing severe cervical myelopathy (p < 0.05), and significantly more cases showing progressed ankylosis in the wrist joint bilaterally (p < 0.01). There were also significantly more patients who received two or more TKA or THA before the cervical spine surgery in the BA + group (p < 0.01).Conclusions: Bony ankylosis of the facet joint of the cervical spine may be a risk factor of instability or stenosis at the adjacent disc level and severe cervical myelopathy. Furthermore, its ankylosis was demonstrated in RA patients with severe destroyed joints.

Spinal Affections in Rheumatological Diseases

A brief resume of management of rheumatoid arthritis in India is highlighted causes of deformity its radiological features and the goals of its management are discussed. Management included medical drug treatment, physical therapy and surgical treatment including synovectomy, osteotomies and joint replacement. Brief description of involvement of cervical spine in rheumatoid arthritis is also made. The evolution of treatment of scoliosis starting from conservative to all stages of surgical treatment is also described. Surgical correction involved posterior instrumentation and fusion anterior release with or without instrumentation and fusion. Treatment of congenital and paralytic scoliosis is also discussed. Newer surgical modalities in treatment of paediatric scoliosis was also highlighted.

Accelerated Development of Cervical Spine Instabilities in Rheumatoid Arthritis: A Prospective Minimum 5-Year Cohort Study

ObjectiveTo clarify the incidence and predictive risk factors of cervical spine instabilities which may induce compression myelopathy in patients with rheumatoid arthritis (RA).MethodsThree types of cervical spine instability were radiographically categorized into “moderate” and “severe” based on atlantoaxial subluxation (AAS: atlantodental interval >3 mm versus ≥10 mm), vertical subluxation (VS: Ranawat value <13 mm versus ≤10 mm), and subaxial subluxation (SAS: irreducible translation ≥2 mm versus ≥4 mm or at multiple). 228 “definite” or “classical” RA patients (140 without instability and 88 with “moderate” instability) were prospectively followed for >5 years. The endpoint incidence of “severe” instabilities and predictors for “severe” instability were determined.ResultsPatients with baseline “moderate” instability, including all sub-groups (AAS+ [VS− SAS−], VS+ [SAS− AAS±], and SAS+ [AAS± VS±]), developed “severe” instabilities more frequently (33.3% with AAS+, 75.0% with VS+, and 42.9% with SAS+) than those initially without instability (12.9%; p<0.003, p<0.003, and p = 0.061, respectively). The incidence of cervical canal stenosis and/or basilar invagination was also higher in patients with initial instability (17.5% with AAS+, 37.5% with VS+, and 14.3% with SAS+) than in those without instability (7.1%; p = 0.028, p<0.003, and p = 0.427, respectively). Multivariable logistic regression analysis identified corticosteroid administration, Steinbrocker stage III or IV at baseline, mutilating changes at baseline, and the development of mutilans during the follow-up period correlated with the progression to “severe” instability (p<0.05).ConclusionsThis prospective cohort study demonstrates accelerated development of cervical spine involvement in RA patients with pre-existing instability—especially VS. Advanced peripheral erosiveness and concomitant corticosteroid treatment are indicators for poor prognosis of the cervical spine in RA.

In vivo 3D kinematics of the upper cervical spine during head rotation in rheumatoid arthritis

The upper cervical spine is commonly involved in persons with rheumatoid arthritis (RA). Although 2D measurements have long been used in the evaluation of cervical lesions caused by RA, 2D measurements are limited in their effectiveness for detecting subtle and complex morphological and kinematic changes. The purpose of this study was to elucidate the 3D kinematics of the upper cervical spine in RA and the relationship between 3D morphological changes and decreased segmental rotational motion. Twenty-five consecutive patients (2 men and 23 women, mean age 63.5 years, range 42-77 years) with RA (the RA group) and 10 patients (5 men and 5 women, mean age 69.9 years, range 57-82 years) with cervical spondylosis and no involvement of the upper cervical spine (the control group) underwent 3D CT of the cervical spine in 3 positions (neutral, 45° head rotation to the left, and 45° head rotation to the right). The segmental rotation angle from the occiput (Oc) to C-2 was calculated for each participant using a voxel-based registration method, and the 3D destruction of articular facets was quantified using the authors' own parameter, the articular facet index. The segmental rotation angle was significantly smaller at C1-2 and larger at Oc-C1 in the RA group compared with the control group. The degree of the destruction of the articular facet at C-1 and C-2 correlated with the segmental rotation angle. In vivo 3D kinematics of the upper cervical spine during head rotation in patients with RA were accurately measured, allowing quantification of the degree of joint destruction for the first time. Joint destruction may play an important role in decreasing segmental motion of the upper cervical spine in RA.

Radiographic changes of the cervical spine in rheumatoid arthritis

IntroductionThe involvement of the cervical spine is a common feature of rheumatoid arthritis (RA). ObjectiveTo study the prevalence of radiographic changes of the cervical spine in patients with RA and their association with clinical and serological profiles of the disease. MethodsWe analysed lateral (neutral position, hyperextension, hyperflexion) and transoral views of cervical spine radiographs from 80 individuals with RA to investigate the presence of atlanto-axial subluxation (AAS), basilar invagination (BI), and subaxial instability (SAI). Demographic, clinical (nodules, interstitial pneumonitis, secondary Sjögren's syndrome, medications etc.), and serologic (rheumatoid factor - RF, cyclic citrullinated peptide antibody – anti-CCP, and antinuclear factor - ANF) data were obtained from the clinical records. ResultsCervical spine misalignments were identified in 26/80 (32.5%) participants; AAS occurred in 12/80 (15%) participants, BI in 6/80 (7.5%), and SAI in 13/80 (32.5%). Odontoid erosions were identified in 16/80 (20.0%) participants. Cervical spine misalignment exhibited associations with age at onset and disease duration (P=0.03 and 0.02, respectively). No associations were identified between the cervical spine changes and the participants’ ethnicity or gender, presence of nodules, interstitial pneumonitis, secondary Sjögren's syndrome, RF, ANF, or anti-CCP. The participants with cervical spine misalignment exhibited higher frequencies of odontoid erosion (P=0.03). ConclusionCervical spine misalignment was a common radiographic finding and occurred more frequently in participants with earlier onset and longer length of RA.

Incidence and Aggravation of Cervical Spine Instabilities in Rheumatoid Arthritis

A prospective minimum 5-year follow-up study of the cervical spine in patients with rheumatoid arthritis (RA) initially without cervical involvement. To clarify the incidence and aggravation of cervical spine instabilities and their predictive risk factors in patients with RA. Many reports have shown the progression of cervical spine involvement in RA. However, few articles have described comprehensive evaluation of its prognostic factors. A total of 140 patients with "definite" or "classical" RA initially without cervical involvement were prospectively followed for more than 5 years. Radiographical cervical findings were classified into 3 instabilities: atlantoaxial subluxation (AAS: atlantodental interval >3 mm), vertical subluxation (VS: Ranawat value <13 mm), and subaxial subluxation (SAS: irreducible translation ≥ 2 mm). "Severe" extents were defined as AAS with atlantodental interval 10 mm or more, VS with Ranawat value 10 mm or less, and SAS with translation 4 mm or more or at multiple levels. Incidence of these developments and predictors for "severe" instabilities were investigated. During 6.0 ± 0.5 years, 43.6% of 140 patients developed cervical instabilities: AAS in 32.1%, VS in 11.4%, and SAS in 16.4% with some combinations. "Severe" instabilities were exhibited in 12.9% of patients: AAS in 3.6%, VS in 6.4%, and SAS in 5.0%. Furthermore, 4.3% presented canal stenosis, with 13 mm or less space available for the spinal cord (SAC) due to "severe" AAS or "severe" VS in 2.9% and 12 mm or less SAC due to "severe" SAS in 2.1%. Multivariable logistic regression analysis identified corticosteroid administration, mutilating changes at baseline, and the development of nonmutilating into mutilating changes during the follow-up period correlated with "severe" instabilities (P < 0.05). A minimum 5-year follow-up reveals the occurrence of cervical instabilities in 43.6%, "severe" aggravation in 12.9%, and decreased SAC in 4.3% of patients with RA. Characteristics of severe disease activity-established mutilating changes, progressive development into mutilating changes, and potentially concomitant corticosteroid treatment-are indicators for poor prognosis of the cervical spine in RA.

Surgical Treatment for Subaxial Lesion of the Cervical Spine in Rheumatoid Arthritis

Surgical Treatment for Subaxial Lesion of the Cervical Spine in Rheumatoid Arthritis

Clinical Study of Cervical Spine in Rheumatoid Arthritis

Clinical Study of Cervical Spine in Rheumatoid Arthritis

Influence of Surgical Extent of Cervical Spine on Post-operative Subaxial Cervical Spine in Rheumatoid Arthritis

Influence of Surgical Extent of Cervical Spine on Post-operative Subaxial Cervical Spine in Rheumatoid Arthritis

Changes of the Cervical Spine in Rheumatoid Arthritis

Changes of the Cervical Spine in Rheumatoid Arthritis

Radiological changes of the upper cervical spine in rheumatoid arthritis.

Radiological changes of the upper cervical spine in rheumatoid arthritis.

A Radiographic Study of the Cervical Spine in Rheumatoid Arthritis

A Radiographic Study of the Cervical Spine in Rheumatoid Arthritis

Timing of cervical spine stabilisation and outcome in patients with rheumatoid arthritis

One complication of rheumatoid arthritis (RA) is the involvement of the cervical spine (CS). Although prophylactic stabilisation is recommended, the timing at which this should occur is poorly defined. The aim of our study was to evaluate the course of neurological symptoms in terms of the timing of surgery. A total of 34 patients with RA and CS involvement were surgically stabilised. These patients were classified using the Ranawat (RW) score both preoperatively and at an average of 54 months post-operatively. For each patient, the presence of atlantoaxial and subaxial subluxation as well as vertical migration of the odontoid was recorded. The anterior atlantodental interval was also assessed pre- and post-operatively. Improvement was obtained in 20 patients, the clinical situation remained unchanged in three patients and three patients manifested disease progression. In terms of the RW score, the 16 patients with pre-operative RW grades I-II showed no deterioration at the post-operative follow-up, with 13 of these patients showing an improvement; the 12 patients with pre-operative RW grades IIIA-IIIB did not show any improvement of neurological symptoms at follow-up, although seven of these patients subjectively assessed the symptoms to be less severe after surgery; three other patients showed a worsening of symptoms. Our results suggest that preventive stabilisation of CS in RA leads to acceptable results, although the complications of the surgery are obvious. However, early operative treatment may delay the detrimental course of cervical myelopathy in RA.

Tetraplegia in rheumatoid arthritis with complete recovery after surgery.

Abstract A patient with tetraplegia caused by subluxation of the lower cervical spine in rheumatoid arthritis is presented. The clinical history, early complication, and delayed diagnosis are described. Compression of the dura mater by rheumatoid granulation tissue and vertebral subluxation are suggested to be responsible for the cord damage. Failure of conservative treatment after a week is a strong indication for surgery. Posterior decompression of the cervical spine and splitting of the dura mater are recommended.

Decreased Muscle Strength and Mobility of the Neck in Patients With Rheumatoid Arthritis and Atlantoaxial Disorders

Häkkinen A, Neva MH, Kauppi M, Hannonen P, Ylinen J, Mäkinen H, Jäppinen I, Sokka T. Decreased muscle strength and mobility of the neck in patients with rheumatoid arthritis and atlantoaxial disorders. Objective To compare neck muscle strength and mobility of the cervical spine in rheumatoid arthritis (RA) patients with and without atlantoaxial (AA) disorders (anterior atlantoaxial subluxation [AAS], AA impaction). Design Clinical cross-sectional study. Setting Outpatient rheumatology and rehabilitation clinics in a Finnish hospital. Participants Patients with RA (N=124; mean age ± standard deviation, 62±y) on a waiting list for orthopedic surgery. Thirty (24%) patients presented with AA disorders (16 with anterior AAS, 8 with AA impaction, 6 with a combination of anterior AAS and AA impaction). Interventions Not applicable. Main Outcome Measures Neck function was measured by isometric neck strength and mobility tests, neck pain by a visual analog scale, erosion of the hands and feet by radiography, and the patients’ function by the Health Assessment Questionnaire (HAQ). Results Maximal neck muscle strength against flexion, extension, and rotation was lower in patients with AA disorders compared with the other patients in both women ( P=.012) and men ( P=.017). Mobility was lowest in the AA impaction group in all measured directions ( P<.001). Peripheral erosive disease was more frequent in the group with AA disorders. They also had longer disease duration and were more disabled (HAQ) than the other patients. Conclusions Neck muscle strength is significantly decreased in patients with AA disorders. Mobility of the cervical spine is most limited in patients with AA impaction, but can be normal in cases with solitary anterior AAS.

Correlation between severity of rheumatoid arthritis and manner and extent of cervical lesion

To determine the proper management of treatment for rheumatoid cervical lesions, we investigated the clinical course of the cervical spine in rheumatoid arthritis (RA). The severity of RA was classified into three groups according to the disease subsets advocated by Ochi et al.: the less erosive subset (LES), the more erosive subset (MES), and mutilating disease (MUD). Then the following radiographic assessments were performed on cervical roentogenograms: atlantoaxial subluxation (AAS), vertical subluxation (VS), and subaxial subluxation (SAS). One hundred and seventy-four patients were available for this study. The mean age of the patients was 60.9 years (19–85 years). The average duration from the onset of RA was 19.1 years (10–40 years). Eighty-seven patients were classified as LES, 69 were MES, and 18 were MUD. We found that few patients in the LES group had required an operation on the cervical spine. AAS was seen in about 60% of the MES patients, but few cases had VS or SAS, and most operations were atlantoaxial fusion. All patients in the MUD group had some cervical instabilities. Not only VS but also SAS were seen in more than half of these patients, and many patients had required occipitothoracic fusion.

The cervical spine in rheumatoid arthritis: relationship between neurologic signs and morphology of MR imaging and radiographs.

Comparison of clinically observed neurologic long tract signs in a heterogeneous group of patients with rheumatoid arthritis (RA), with morphologic abnormalities of the cervical spine as depicted on radiographs and magnetic resonance (MR) images. The patients were prospectively assigned to one of three classes on the basis of their neurologic status. Lateral cervical spine radiographs and sagittal T1-weighted and gradient echo images were performed. The qualitative MR features evaluated were erosion of the dens and atlas, brain stem compression, subarachnoid space encroachment, pannus around the dens, appearance of the fat body caudal to the clivus, and the signal intensity of the pannus. The quantitative imaging parameters were the cervicomedullary angle and the distance of the dens to the line of McRae. Sixty-three consecutive patients with RA and subjective symptoms, especially neck or occipital pain, and/or clinical objective signs consistent with a compromised cervical cord were included in this study. Damage documented with radiographs and MR imaging in patients with RA is often severe, even in those without neurologic signs (class 1). None of the abnormalities confined to the atlantoaxial level correlated significantly with neurologic classification. Subarachnoid space encroachment anywhere in the entire cervical spine did correlate significantly with neurologic classification.