Contribution of dynamic radiographs in atlantoaxial subluxation in rheumatoid arthritis
Keywords:
Rheumatoid arthritis; atlantoaxial subluxation; X-Ray; dynamic views; predictive factors.Abstract
Background: Cervical spine (CS) involvement is common during rheumatoid arthritis (RA) and it is distinguished by its potential gravity. Aim: To determinate the occurrence of atlantoaxial subluxation (AAS) by dynamic incidences X-Ray and to assess its predictive factors.
Methods: Our study included a cohort of 40 patients carrying RA, who fulfilled the American College of Rheumatology criteria, for more than 2 years. All patients had a complete physical and laboratory evaluation. Radiological evaluation included CS radiographs in anteroposterior, lateral, and lateral in full flexion and extension views.
Results: The occurrence of CS involvement was about 47.5% by XRay dominated by AAS which found in 42,5% of the cases. Among AAS, anterior AAS was the most frequent with a prevalence of 22,5% followed by lateral AAS in 12,5% then vertical and rotatory AAS in 10% of cases each one and posterior AAS in 2,5% of the cases. Comparison between patients with and without CS involvement indicated the presence of two predictive factors: the sharp modified score and the C - reactive protein (p=0.002 and p=0.004 respectively).
Conclusion: Our study demonstrated that AAS is frequent in RA particularly in active forms with structural lesions. AAS can be asymptomatic, for this reason systematic diagnosis by X-Ray with dynamic views is important.
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ZIKOU AK, ALAMANOS Y, ARGYROPOULOU MI, TSIFETAKI N, TSAMPOULAS C, VOULGARI PV. Radiological cervical spine involvement in patients with rheumatoid arthritis: a cross sectional study. J Rheumatol 2005; 32: 801-6.
NGUYEN HV, LUDWIG SC, SILBER J ET AL. Rheumatoid arthritis of the cervical spine. Spine J. 2004; 4: 329-34.
REYNOLDS H, CARTER SW, MURTAGH FR, RECHTINE GR. Cervical rheumatoid arthritis: value of flexion and extension views in imaging. Radiology 1987; 164:215-8
BOUCHAUD-CHABOT A, LIOTE´ F. Cervical spine involvement in rheumatoid arthritis. Joint Bone Spine 2002; 69: 141-54.
NEVA MH, ISOMAKI P, HANNONEN P, KRISHNAN E. Early and extensive Erosiveness in Peripheral Joints Predicts Atlantoaxial Subluxations in Patients with Rheumatoid Arthritis. Arthritis Rheum 2003; 48: 1808-13
AIMELA L, LAASONEN L, KANKAANPAA E, LERISALO-REPOM. Progression of cervical spine changes in patients with early rheumatoid arthritis. J Rheumatol 1997; 24: 1280-4.
ARNETT FC, EDWORTHY SM, BLOCH DA. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315-24
VAN DER HEIJDE D. How to read radiographics according to the Sharp/ Van Der Heijde method. J Rheumatol, 2000; 27: 261-63.
PELLICCI P, RANAWAT C, TSAIRIS P, BRYAN W. A prospective study of the progression of rheumatoid arthritis of the cervical spine. J Bone Joint Surg 1981; 63A: 342-50
MC GREGOR M. The significance of certain measurements of the skull in the diagnosis of basilar impression. Br J Radiol 1948; 21: 171-81.
RANAWAT CS, O'LEARY P, PELLICI P, DORR L. Cervical spine fusion in rheumatoid arthritis. J Bone Joint Surg 1979; 61A : 1003-10.
KAUPPI M, SAKAGUCHI M, KONTTINEN YT, HAMALAINEN M. A new method of screening for vertical atlantoaxial dislocation. J Rheumatol 1990; 17: 167-72.
. ROCHE CJ, EYES BE, WHITEHOUSE GH. The rheumatoid cervical spine: signs of instability on plain cervical radiographs. Clin Radiol 2002; 57: 241-9. 14. ZOLI A, PR
. ZOLI A, PRIOLO F, GALOSSI A. Craniocervical junction involvement in rheumatoid arthritis: a clinical and radiological study. J Rheumatol 2000; 27: 1178-82.
. NEVA M, HAKKINEN A, MAKINEN H ET AL. Prevalence of radiological changes in the cervical spine. A cross sectional study after 20 years from presentation of rheumatoid arthritis. J Rheumatol 2000; 27:90-3
WASSERMAN BR, MOSKOVICH R, RAZI AE. Rheumatoid arthritis of the cervical spine--clinical considerations. Bull NYU Hosp Jt Dis 2011; 69:136-48
LEHTO EM, HEIKKILA S, KOUTIAINEN H, KAUPPI MJ. The clinical picture of atlantoaxial subluxation changes when atlantoaxial impaction develops. Joint Bone Spine, 2010; 77:159-64
REICHEL H, LIEBHABER A, BABINSKY K, KEYSSER G. Radiological changes in the cervical spine in rheumatoid arthritis: prognostic factors obtained by a cross-sectional study. Z Rheumatol 2002; 61: 710-7.
BODEN SD. Rheumatoid arthritis of the cervical spine. Surgical decision making based on predictors of paralysis and recovery. Spine 1994; 19: 2275-80
KAUPPI M, HAKALA M. Prevalence of cervical spine subluxations and dislocations in a community based rheumatoid arthritis population. Scand J Rheumatol 1994; 23: 133-6.
KAUPPI M, SAKAGUCHI M, KONTINNEN YT. Pathogenic mechanism and prevalence of the stable atlantoaxial subluxation in rheumatoid arthritis. J Rheumatol 1996; 23: 831-34
BUNTON RW, GRENNAM DM, PALMER DG, DE SILVA RTD. Lateral subluxation of the atlas in rheumatoid arthritis. Br J Radiol 1978; 51: 963- 67.
VESELA M, STETKAROVA I, LISY J. Prevalence of C1/C2 involvement in Czech rheumatoid arthritis patients, correlation of pain intensity, and distance of ventral subluxation. Rheumatol Int. 2005; 26: 12-15
HALLA J, HARDIN J. The spectrum of atlantoaxial facet joint involvement in rheumatoid arthritis. Arthritis Rheum 1990; 33: 325-29.
NEVA MH, HAKKINEN A, MAKINEN H, HANNONEN P. High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopedic surgery. Ann Rheum Dis 2006; 65: 884-88
LIPSON SJ. Cervical myelopathy and posterior atlantoaxial subluxation in patients with rheumatoid arthritis. J Bone Joint Surg 1985; 67: 593-7.
KAUPPI M, NEVA MH. Sensitivity of Lateral View Cervical Spine Radiographs Taken in the Neutral Position in Atlantoaxial Subluxation in Rheumatic Diseases. Clin Rheumatol 1998; 17: 511-14
CASTRO S, VERSTRAETE K, MIELANTS H. Cervical spine involvement in rheumatoid arthritis: a clinical, neurological and radiological evaluation. Clin Exp Rheumatol 1994; 12: 369-74.
KARHU JO, PARKKOLA RK, KOSKINEN SK. Evaluation of flexion/extension of the upper cervical spine in patients with rheumatoid arthritis: an MRI study with a dedicated positioning device compared to conventional radiographs. Acta Radiol 2005; 46: 55-66
ZIKOU AK, ARGYROPOULOU MI, ALAMANOS Y, TSIFETAKI N, DROSOS AA. Magnetic resonance imaging findings of the cervical spine in patients with rheumatoid arthritis. A cross-sectional study. Clin and Exp Rhumatol 2005; 23: 665-70.
PISITKUN P, PATTAROWAS C. Reappraisal of cervical spine subluxation in Thai patients with rheumatoid arthritis. Clin Rheumatol 2004; 23: 14-8
LAIHO K, KAARELA K, KAUPPI M. Cervical Spine Disorders in Patients with Rheumatoid Arthritis and Amyloidosis. Clin Rheumatol 2002; 21: 227-30.
DAOUD L, KOCHBATI S. Magnetic resonance imaging evaluation of the cervical spine in patients with rheumatoid arthritis. Report of 30 cases. Tunis Med 2009; 87: 375-9
DE RYCKE L, PEENE I, HOFFMAN E, KRUITHOF E, MEHEUS L. Rheumatoid factor and anticitrullinated protein antibodies in rheumatoid arthritis: diagnostic value, associations with radiological progression rate and extra-articular manifestations. Ann Rheum Dis 2004; 63: 1587-93.
SHARP J, PURSER DW, LAWRENCE JS. Rheumatoid arthritis of the cervical spine in the adult. Ann Rheum Dis 1958; 17: 303-13.
WINFIELD J, YOUNG A, WILLIAMS P, CORBETT M. Prospective study of the radiologic changes in hands, feet, and cervical spine in adult rheumatoid disease. Ann Rheum Dis 1983; 42: 613-8.
NEVA MH, KAUPPI MJ, KAUTIAINEN H. Combinaition drug therapy retards the development of rheumatoid atlantoaxial subluxations. Arthritis Rheum 2000; 43: 2397-401
GAYLIS NB, NEEDELL SD, RUDENSKY D. Comparison of in-office magnetic resonance imaging versus conventional radiography in detecting changes in erosions after one year of infliximab therapy in patients with rheumatoid arthritis. Mod Rheumatol 2007; 17: 273-8.
COLLINS DN, BARNES CS, FITZRANDOLPH RL. Cervical Spine instability in rheumatoid patients having total hip or knee arthroplasty. Clin Orthop 1991; 272: 127-35.
