Atlanto-occipital dislocation in rheumatoid arthritis

Area of Science:

• Rheumatology
• Orthopedics
• Neurology

Background:

• Atlanto-occipital dislocation (AOD) is a severe instability at the craniocervical junction.
• Rheumatoid arthritis (RA) can affect the cervical spine, leading to various complications.
• AOD in RA patients is infrequently reported, making its prevalence and diagnostic challenges significant.

Observation:

• This study describes four cases of atlanto-occipital dislocation.
• Two cases were identified in a cohort of 407 rheumatoid arthritis patients, suggesting a frequency of 0.5%.
• All affected patients presented with severe, mutilating peripheral joint disease, cervical spine involvement, and profound neurological deficits.

Findings:

• Atlanto-occipital dislocation is a rare complication of rheumatoid arthritis.
• Patients with AOD associated with RA exhibit severe joint destruction and neurological compromise.
• Conventional radiography may not be sufficient for diagnosing AOD in this population.

Implications:

• Computed tomography (CT) is recommended for accurate diagnosis of AOD in RA.
• Early recognition and advanced imaging are vital for timely intervention in these complex cases.
• Understanding the incidence of AOD in RA can inform clinical vigilance and management strategies.