Cervical Spine Involvement in Patients with Rheumatoid Arthritis: Radiographic and MRI Findings in the Era of Biological Treatment

 

Presentation Format: Oral presentation.

Purpose or Learning Objective: Cervical spine involvement in rheumatoid arthritis (RA) may lead to severe neurologic dysfunction or even sudden death. The clinical diagnosis of cervical spine involvement often is challenging, due to nonspecific symptoms. Thus imaging plays an important role in the diagnosis of cervical spine pathologies in RA. The goal of our retrospective study was the analysis of radiographic and magnetic resonance imaging (MRI) features of cervical spine involvement in patients diagnosed with RA.

Methods or Background: We enrolled 240 patients (86% women; median age: 62 years) diagnosed with RA and clinical symptoms suggesting cervical spine involvement. Every patient had both radiography and MRI performed.

The imaging findings were correlated with clinical (age, sex, disease duration, and current treatment) and laboratory data: erythrocyte sedimentation (ESR) rate, C-reactive protein (CRP), presence of rheumatoid factor (RF), antinuclear antibodies, and anticyclic citrullinated peptide antibodies.

Results or Findings: The cervical spine involvement was seen in 179 patients (75%). The most common detected lesions were anterior atlantoaxial subluxation (AAS) (58%), subaxial subluxation (58%), and demineralization (48%). Cervical spine involvement was linked with longer disease duration (p = 0.007), presence of rheumatoid factor (p = 0.010), and elevated CRP (p = 0.016) and ESR (p = 0.025). Subaxial subluxation was associated with longer disease duration (p = 0.005), as well as basilar setting (p = 0.003). Basilar setting prevalence was lower in a group treated with methotrexate (p = 0.041). Anterior AAS was associated with longer disease duration (p = 0.005), elevated CRP (p = 0.033) and ESR (p = 0.024), and the presence of RF (p = 0.036). Demineralization (osteoporosis or osteopenia) was associated with longer disease duration (p = 0.005) and age (p < 0.001). Dens erosions were more prevalent in male patients (p = 0.034).

Conclusion: The risk factors of cervical spine involvement in RA include long disease duration, RF seropositivity, and elevated inflammatory markers. Basilar setting, anterior AAS, subaxial subluxation, and demineralization are chronic lesions. Dens erosions may be seen at any stage of RA. Current treatment with methotrexate may inhibit development of basilar setting. However, in 75% of patients with clinical symptoms, cervical spine involvement is still an issue in RA.

Publication History

Article published online:
03 June 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA