RESEARCH - RA of the cervical spine - an underestimated problem

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Dtsch Med Wochenschr. 2005 Aug 19;130(33):1866-70.

[Rheumatoid arthritis at the cervical spine -- an underestimated problem]

[Article in German]

Schwarz-Eywill M, Friedberg R, Stosslein F, Unger L, Nusslein H.

I. Medizinische Klinik, Schwerpunkt Rheumatologie/Klinische Immunologie,

Klinikum Dresden-Friedrichstadt, Dresden.

BACKGROUND AND OBJECTIVE: The involvement of the cervical spine in

rheumatoid arthritis can be essential regarding prognosis and mortality. The

cervical myelopathy due to pannus formation and/or subluxation can be fatal.

Aim of this study was to demonstrate the possible changes seen by MRI, and

to establish a risk-profile for the individual patient. PATIENTS AND METHOD:

Within a period of 24 months 214 patients with active RA were included.

Clinical and laboratory data were obtained and plain radiographs of the

cervical spine were taken. In patients with pathological findings on X-ray

an MRI was performed (36 patients). RESULTS: Within the group of 214

patients 36 were identified to get an cervical spine MRI. In all cases the

MRI showed significant changes: in 7 (19.5 %) pannus surrounded the dens,

with additional erosions in one patient (2.7 %). In 25 (69.5 %)

atlanto-axial-subluxation was present, 7 (19.5 %) showed a spondylodiscitis

below C2. In 10 (27.8 %) a cervical myelopathy due to pannus or subluxation

was present. There was no correlation of the MRI-results with symptoms and

findings by examination. The patients with cervical spine disease were in

all stages of RA. The majority was rheumatoid-factor positive. 5 out of 10

patients with cervical myelopathy showed neurological deficits: 3 patients

died in consequence of neural compression, 2 patients underwent surgery

successfully.

CONCLUSION: The early detection of a cervical spine involvement in RA is

essential to avoid possibly fatal complications. The only reliable method to

achieve this goal has to include radiographic diagnostic including MRI of

the cervical spine. Only this approach can answer the question of the right

time-point for surgery. In daily clinical practice the cervical-spine

involvement in RA is still underestimated.

PMID: 16118728

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16118728 & itool=iconabstr & query_hl=1

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