title: Natural course of cervical spine lesions in rheumatoid arthritis.
abstract: METHODS
  This study analyzed the natural course of cervical spine involvement in rheumatoid arthritis by serial radiographs.
  
  
  OBJECTIVE
  The purpose was to determine the pattern of progression of cervical spine lesions in rheumatoid arthritis and predictors for the extent of progression.
  
  
  BACKGROUND
  Subluxation frequently occurs as a result of rheumatoid involvement of the cervical spine. It may be severe in patients with mutilans deformities in the hands and feet. The extent of progression in a given patient is still unpredictable.
  
  
  METHODS
  Serial cervical radiographs in 49 patients with rheumatoid arthritis were analyzed. The extent of progression was evaluated by rheumatoid arthritis subset defined previously, which reflected the final extent of joint erosion in this systemic disease and could be roughly classified during early stages of the disease.
  
  
  RESULTS
  In the upper cervical spine, reducible anterior atlantoaxial subluxation occurred first. Vertical subluxation of the axis appeared next. Irreducible change of preceding anterior atlantoaxial subluxation was a sign of the start of vertical subluxation. In subaxial lesion, subluxation occurred less frequently (22.4%) than upper cervical lesion (77.6%). The extent of progression was different with the rheumatoid arthritis subset. In the upper cervical spine, none of the subset with least erosive disease developed vertical subluxation, whereas 52% of the subset with more erosive disease and 88% of the subset with mutilating disease advanced to vertical subluxation. The extent of progression was well correlated with the number of joints with erosion. Subaxial subluxation was often seen and became irreducible in mutilating disease and more erosive disease, but not in least erosive disease.
  
  
  CONCLUSIONS
  A progressive pattern of the upper cervical subluxations was clarified. That is, upper cervical lesions progressed from reducible anterior atlantoaxial subluxation to irreducible anterior atlantoaxial subluxation with vertical subluxation. This extent of progression was different with the rheumatoid arthritis subset, which was also related to the development of subaxial subluxation. The most aggressive arthritis classification, a subset with mutilating disease, had the more severe subluxation in both upper and subaxial cervical spine.
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Medical School, Suita, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Oda
authors.forename: K
authors.initials: K
authors.lastname: Fujiwara
authors.forename: K
authors.initials: K
authors.lastname: Yonenobu
authors.forename: B
authors.initials: B
authors.lastname: Azuma
authors.forename: T
authors.initials: T
authors.lastname: Ochi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging*; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies