Study Design: This study analyzed the natural course of cervical spine involvement in rheumatoid arthritis by serial radiograph.
Objectives: The purpose was to determine the pattern of progression of cervical spine lesions in rheumatoid arthritis and predictors for the extant of progression.
Summary of Background Data: Subluxation frequently occurs as a result of rheumatoid involvement of the cervical spine. It may be severe in patients with mutilans deformities in the hands and feet. The extent of progression in a given patient is still unpredictable.
Methods: Serial cervical radiographs in 49 patients with rheumatoid arthritis were analyzed. The extent of progression was evaluated by rheumatoid arthritic were analyzed. The extent of progression was evaluated by rheumatoid arthritic subset defined previously, which reflected the final extent of joint erosion in this systemic disease and could be roughly classified during early stages of the disease.
Results: In the upper cervical spine, reducible anterior atlantoxial subluxation occured first, Vertical subluxation of the axis appeared next. Irreducible change of preceding anterior atlantoaxial subluxation was a sign of the start of vertical subluxation. In subaxial lesion, subluxation occured less frequently (22.4%) than upper cervical lesion (77.6%). The extent of progression was different with the rheumatoid arthritis subset. In the upper cervical spine, none of the subset with least erosive disease developed vertical subluxation. Whereas 52% of the subset with more erosive disease and 88% of the subset with multilating disease advanced to vertical subluxation. The extent of progression was well correlated with the number of joints with erosion. Subaxial subluxation was often seen and became irreducible in multilating disease and more erosive disease, but not in least erosive disease.
Conclusions: A progressive pattern of the upper cervical subluxations was clarified. That is, upper cervical lesions progressed from reducible anterior atlantoxial subluxation to irreducible anterior atlantoxial subluxation with vertical subluxation. This extent of progression was different with the rheumatoid arthritis subset, which also related to the development of subaxial subluxation. The most aggressive arthritis classification, a subset with multiating disease, had the more servere subluxation in both upper and subaxial cervical spine.
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