Cervical spine involvement in rheumatoid arthritis: prevalence and relationship with overall disease severity

Rheumatoid arthritis (RA) affects the cervical spine in 20-90% of patients in Western countries. We report the prevalence of cervical spine involvement in RA and its relationship with duration of disease, seropositivity, hand joint erosions and symptoms and signs suggestive of cervical spine involvement. 100 patients with RA criteria were included. Apart from clinical history and examination, study included X-rays of the cervical spine in AP, open mouth and lateral views and posteroanterior view of hands and rheumatoid factor estimation. All X-rays were read by a radiologist who was unaware of the clinical details. Cervical spine involvement was seen in 65% of patients. The commonest abnormality was erosions of the odontoid process (47%), followed by atlanto-axial dislocation and apophyseal joint involvement (24%). Only 5% of patients had abnormalities of spinous processes or vertebral bodies. Patients with abnormal cervical spine radiographs had higher prevalence of rheumatoid factor and erosions on hand radiographs. Severity of cervical spine changes was related to duration of disease (> 5 years). No correlation was seen between symptoms and radiological abnormalities except when neurological deficit was present. Patients with seropositivity, erosive disease and disease duration greater than five years should be screened for cervical spine disease.