Natural history of atlanto-axial subluxation in rheumatoid arthritis

In 1969 the authors started their prospective study to determine the natural history of atlanto-axial subluxation in patients suffering from rheumatoid arthritis. Between January 1969 and July 1971 they accumulated 41 cases of atlanto-axial subluxation. These patients were studied clinically and radiologically, and the initial findings were published in the Journal of Bone and Joint Surgery, Volume 55B, August 1973. All of these patients were followed clinically and radiologically until 1981 or until their demise. Roentgenographically, 61% have remained unchanged, 27% have shown progression of the atlanto-axial subluxation, and 12% showed decrease in the amount of atlanto-axial subluxation, including one following surgery. During this 10-year period, 12 patients with atlanto-axial subluxation have died, two with historical evidence of neurologic damage. The remaining 10 patients have died from unrelated causes. Only 3 patients underwent surgical stabilization. This study concluded that the atlanto-axial subluxation is compatible with life, but some patients require surgical intervention.