Rheumatoid Arthritis Of The Cervical Spine

摘要

70 patients with rheumatoid arthritis of at least two years duration, were assessed clinically and radiologically for cervical spine involvement. Cervical spine involvement was found radiologically in 64 % cases and clinically in 57 % cases. Atlantoaxial subluxation in 8 , subaxial subluxation in 24 and basilar invagination in 2 patients was present. Though subluxations were common, neurological symptoms were present in only 8 out of total 70 patients studied. Atlantoaxial instability, and presence of neurologic deficit were indication for surgery which may be also be required in seemingly asymptomatic patients to prevent life threatening instabilities and irreversible damage t nervous tissue. Introduction Cervical spine involvement in rheumatoid arthritis is frequent and is next to hand and feet involvement in terms of frequency1. The disease start from hyperactive inflammatory synovium that causes ligamentous destruction, subsequent hypermobility and mechanical degeneration resulting into atlantoaxial subluxation, subaxial subluxation and basilar invagination which may result in irreversible neurological damage1,2,3. The present study was undertaken to study the pattern of involvement of cervical spine and its management in rheumatoid arthritis patients at our institute. Material and Methods Patients with established rheumatoid arthritis of at least two years duration, who attended OPD from 1st January 2004 to 31st December 2004, were included in this study. Patients having history of significant trauma to neck were excluded. Radiological and clinical evaluation of these patients was undertaken. Patients were evaluated for neck pain and neurological status. It may be difficult to assess exact muscle power in presence of severe polyarticular disease.Radiological examination of cervical spine in form of antero-posterior and profile bending X-rays of the cervical spine were undertaken. They were observed for : Anterior atlanto-dense interval(ADI). Sub axial subluxations (SAS) Disk space narrowing. Facet joints Any other abnormality. A total of 70 patients were included in this study. According to clinical presentation the group was divided into groups having painful neck and asymptomatic neck. Medical management was in the form of NSAIDS, disease modifying drugs, local heat, neck exercises and intermittent use of cervical collar. Indications for surgical intervention were presence of neurological deficit, severe pain and anterior atlanto-dense interval of more than 5mm. Results There were total 70 patients (62 females and 8 males) in our study with average age of 39.5 years(24-54 years). The mean duration of disease is 6.5 years (2-20 years).