General diseases of the spine in rheumatoid arthritis

The past year has contributed to a better understanding of the management of cervical spine instability in patients with rheumatoid arthritis. Neurologic recovery after surgery is better and the percentage of recurrence is lower in cases of isolated atlantoaxial subluxation (AAS) compared with cases of AAS associated with basilar invagination or with subaxial subluxation. This suggests that the sooner surgery is undertaken in limited AAS, the better the outcome. The atlantoaxial posterior interval seems to be the best predictor of neurologic recovery following posterior fusion for AAS. Osteoporosis is a major problem in patients with rheumatoid arthritis. Recent studies show that corticosteroids, even in a low dosage, contribute to spinal bone loss. This bone loss may be partially reversible after ceasing corticoid therapy. A new corticosteroid, deflazacort, which does not inhibit intestinal absorption of calcium, seems to limit bone loss.