Active conservative treatment of atlantoaxial subluxation in rheumatoid arthritis

Twenty patients with rheumatoid atlantoaxial subluxation (AAS) underwent an active conservative treatment programme, aiming at relieving the symptoms and influencing the natural course of AAS. The treatment consisted of intensive multiprofessional intervention in the hospital for a fortnight, and control and motivational visits 6 and 12 months later. The patients self-evaluated the symptoms several times, and the cervical spine radiographs were taken at the first and last visit. Seventeen of the 20 patients adopted the instructions well and undertook the exercise programme at least weekly, even after a 12 month follow-up. Cervical pain was significantly reduced (P < 0.001) during the first intervention, and the favourable effect continued at least 12 months. Promising changes were also seen in some cervical radiographs. It is possible to educate and motivate AAS patients to take active care of their neck, and to relieve their chronic neck pain significantly. Atlantoaxial instability may also be reduced during active conservative treatment.