[Changes in the cervical spine in chronic polyarthritis]

Area of Science:

• Rheumatology
• Orthopedics
• Radiology

Background:

• Chronic polyarthritis, specifically rheumatoid arthritis (RA), is a systemic autoimmune disease.
• RA commonly affects joints, but can also involve the cervical spine, leading to significant morbidity.
• Understanding the prevalence and risk factors for cervical spine involvement in RA is crucial for patient management.

Purpose of the Study:

• To investigate the frequency of various inflammatory cervical spine lesions in patients with rheumatoid arthritis.
• To identify correlations between cervical spine involvement and disease severity markers, treatment modalities, and disease duration.

Main Methods:

• Retrospective analysis of 93 patients meeting at least five American Rheumatism Association (ARA) criteria for classical chronic polyarthritis (rheumatoid arthritis).
• Radiographic assessment of the cervical spine for specific lesions including dens epistropheus inflammation, atlantoaxial subluxations/dislocations, pseudobasilar invagination, step-ladder subluxation, discitis, and spondylarthritis.
• Correlation analysis with clinical and laboratory parameters such as Steinbrocker-Grade, antinuclear antibody (ANA) levels, Waaler-Rose test, duration of disease, and treatment history (steroids, gold therapy).

Main Results:

• High prevalence of cervical spine lesions observed: inflammatory dens epistropheus (48.4%), ventral atlantoaxial subluxation (25.8%), lateral atlantoaxial dislocation (14%), pseudobasilar invagination (5.4%).
• Step-ladder subluxation (C2-C7) in 31.2%, discitis in 12.5%, and spondylarthritis in 38% of cases.
• Significant correlations found between cervical spine inflammation and advanced RA (Steinbrocker-Grade IV), elevated ANA levels, and high Waaler-Rose titers. Long-standing steroid therapy was associated with increased cervical involvement, particularly at C1/C2. Conversely, long-term gold therapy showed a protective association with cervical spine lesions.

Conclusions:

• Cervical spine inflammatory lesions are common in rheumatoid arthritis patients.
• Disease severity markers and long-term steroid use are associated with increased risk of cervical spine involvement.
• Gold therapy may have a protective effect against the development of cervical spine lesions in rheumatoid arthritis.