The cervical spine in rheumatoid arthritis: relationship between neurologic signs and morphology of MR imaging and radiographs.
OBJECTIVE
Comparison of clinically observed neurologic long tract signs in a heterogeneous group of patients with rheumatoid arthritis (RA), with morphologic abnormalities of the cervical spine as depicted on radiographs and magnetic resonance (MR) images.


METHODS
The patients were prospectively assigned to one of three classes on the basis of their neurologic status. Lateral cervical spine radiographs and sagittal T1-weighted and gradient echo images were performed. The qualitative MR features evaluated were erosion of the dens and atlas, brain stem compression, subarachnoid space encroachment, pannus around the dens, appearance of the fat body caudal to the clivus, and the signal intensity of the pannus. The quantitative imaging parameters were the cervicomedullary angle and the distance of the dens to the line of McRae.


METHODS
Sixty-three consecutive patients with RA and subjective symptoms, especially neck or occipital pain, and/or clinical objective signs consistent with a compromised cervical cord were included in this study.


CONCLUSIONS
Damage documented with radiographs and MR imaging in patients with RA is often severe, even in those without neurologic signs (class 1). None of the abnormalities confined to the atlantoaxial level correlated significantly with neurologic classification. Subarachnoid space encroachment anywhere in the entire cervical spine did correlate significantly with neurologic classification.
Reijnierse
M
M
Department of Diagnostic Radiology and Nuclear Medicine, Leiden, The Netherlands.
Bloem
J L
JL
Dijkmans
B A
BA
Kroon
H M
HM
Holscher
H C
HC
Hansen
B
B
Breedveld
F C
FC
D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011446:Prospective Studies; D011859:Radiography; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology