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Upper cervical instability associated with rheumatoid arthritis: a case report
1University of Evansville, IN, USA; Ola Grimsby Institute, UT, USA.
The Journal of Manual & Manipulative Therapy
|August 26, 2016
Summary
Rheumatoid arthritis (RA) patients often have atlantoaxial instability (AAI), but few show symptoms. Therapists must consider AAI risks before cervical spine treatment, even without obvious signs.
Area of Science:
- Rheumatology
- Orthopedics
- Physical Therapy
Background:
- Rheumatoid arthritis (RA) impacts 1-2 million Americans.
- Atlantoaxial instability (AAI) affects 40-85% of RA patients.
- Craniovertebral instability is common in RA, yet often asymptomatic.
Observation:
- High prevalence of AAI in RA patients.
- Limited overt symptoms despite high instability risk.
- Potential for contraindications in cervical spine therapy.
Findings:
- Case study highlights diagnostic complexity of AAI in RA.
- Illustrates clinical reasoning for AAI management.
- Emphasizes need for diagnostic imaging before cervical therapy.
Implications:
- Increased therapist suspicion for AAI in RA patients.
- Importance of pre-treatment diagnostic imaging for cervical spine interventions.
- Need for careful clinical reasoning in managing RA patients with potential AAI.