Rheumatoid arthritis of the cervical spine: early and progressive radiographic features

One hundred thirty-three cervical spine radiographs of 50 patients with rheumatoid arthritis were examined. The patients were a representative random sample chosen from among 675 patients followed up for more than 10 years. The frequency of occurrence for each radiographic finding was correlated with the duration of rheumatoid arthritis. The six radiographic findings that occurred in 30% or more of patients with a disease duration of less than 10 years included odontoid erosions, subaxial subluxation, superficial apophyseal joint erosions, apophyseal joint sclerosis at levels C-4 through C-7, and diskovertebral joint narrowing and osteophytosis at C-4 through C-7. Familiarity with these early findings in the cervical spine may be helpful in both diagnosing and managing rheumatoid arthritis. Subaxial subluxation and superficial apophyseal joint erosions did not progressively increase in frequency with increasing duration of disease, but the other four features did. Other features that were uncommon in early disease became significantly more frequent in later decades.