The Cervical Spine Involvement in Rheumatoid Arthritis

摘要

Background and Objectives: There is not any information about the cervical spine involvement and risk factors of that in the patients with rheumatoid arthritis in Azerbaijan of Iran. We conducted this study to consider the frequency of cervical spine involvement in the patients with rheumatoid arthritis in Azerbaijan of Iran and to correlate the different factors reflecting the disease severity with the involvement of cervical spine.Settings and design: From April 2009 to September 2010, 100 consecutive unselected patients with RA being followed at the outpatient rheumatology clinic of the University Hospital of Sina were investigated.Patients and methods: We investigated 100 consecutive unselected patients with rheumatoid arthritis who fulfilled the revised American College of Rheumatology criteria for rheumatoid arthritis. All patients had a complete physical and laboratory evaluation. Patients had a radiological evaluation of cervical spine in anteroposterior, lateral, and lateral in full flexion views. Radiographs were evaluated according to Winfield classification.Results: There were 79 women (79%) and 21 men (21%) with a mean age of disease 45.6 ± 11.9 years and mean disease duration 5.86 ± 5.43 years. Forty (40%) patients presented radiological findings suggesting cervical spine involvement. Common radiological findings were disc space narrowing (27%), anterior atlantoaxial subluxation (17%), subaxial subluxation (14%) and apophyseal joint erosion (11%). There is significant correlation between disease duration with SAS and disc space narrowing and DAS28 with disc space narrowing.Conclusions: Plain radiographs of the cervical spine should be obtained regularly to seek cervical spine manifestations even in patients without cervical symptoms. Introduction Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder of unknown etiology characterized by erosive synovitis. It affects 0.33 of the Iranian people.1 Cervical spine involvement is one of the causes of morbidity and mortality in the patients with rheumatoid arthritis. The frequency of cervical spine involvement varies largely depending on the series reviewed. It has been reported to be in 17-86% of patients with RA.2 The most important cervical spine involvement in RA is atlantoaxial subluxation (AAS), which may be horizontal or vertical in direction. However, significant subaxial disease is common and usually coexists with the AAS.3, 4 Although radiological abnormalities may remain asymptomatic for years, these patients are at continued risk of neurological complications and even sudden death from medullary compression. The association between various clinical factors and cervical spine involvement in RA spine has been investigated.5-9 However, there has been little investigation about the relationship between the various clinical and laboratory factors and type of radiographic cervical spine involvement in RA.There is not any information about the cervical spine involvement and risk factors of that in the patients with rheumatoid arthritis in Azerbaijan of Iran. We conducted this study to consider the frequency of cervical spine involvement in the patients with rheumatoid arthritis in Azerbaijan of Iran and to correlate the different factors reflecting the disease severity with the involvement of cervical spine. Materials and methods From April 2009 to September 2010, 100 consecutive unselected patients with RA being followed at the outpatient rheumatology clinic of the University Hospital of Sina were investigated. The study has been approved by the ethical committee of Tabriz University of Medical Sciences. Informed consent was obtained from the participants. All patients fulfilled the revised American College of Rheumatology criteria (ACR).10 Patients with pregnancy, neck trauma, neck infections, or congenital abnormalities were excluded from the study.The following parameters were entered on a questionnaire:Radiography of anteroposterior, lateral in