Clinical and radiological investigations on cervical spine involvement in rheumatoid arthritis in adults

The radiological and clinical features of cervical spine involvement observed in 49 patients with rheumatoid arthritis are described. The forward atlas-odontoid subluxation, after an x-ray with full flexion of the cervical spine, occurred in 36.9% of the cases. The upward subluxation was found in 8 (17.4%) cases, but only in one (2.2%) case it was of high degree. In one case lateral subluxation could be suspected by the asymmetrical involvement of the atlanto-axial joints. Erosions of the odontoid peg, subluxation at various levels, discitis and osteoporosis with various frequency were observed. A statistically significant relation has been observed between duration of the disease and radiological signs at the level C1-C2; between radiological features and severity of general clinic picture; between cervical lesions at the level C1-C2 and presence of osteolysis affecting hands, wrists, feet. Clinically, signs concerned with cervical spine involvement were found in 83.6%. Besides cervical pain and functional limitation, the headache was the most frequent clinical sign. It was confined to the occipital region in 69.4% of the cases, and was present at awakening or occurred in connection with movements of the cervical spine and head (53.1%). This study confirms the frequent involvement of the cervical spine in rheumatoid arthritis and shows that performing a complete examination of C1-C2 area is useful, in the most serious forms of RA, since the third year of course.