title: Prevalence of radiological changes in the cervical spine--a cross sectional study after 20 years from presentation of rheumatoid arthritis.
abstract: OBJECTIVE
  To evaluate the prevalence of cervical spine changes in patients with rheumatoid factor (RF) positive rheumatoid arthritis (RA) followed prospectively for 20 years.
  
  
  METHODS
  An inception cohort of 103 patients with RF positive RA have been followed at the Rheumatism Foundation Hospital, Heinola. A total of 68 patients attended for the 20 year followup. An additional 28 patients died and 7 were not able to attend due to severe disease or old age. The plain cervical spine radiographs of 69 patients (68 and one received from another hospital) taken after 20 years of RA were evaluated.
  
  
  RESULTS
  Anterior atlantoaxial subluxation was found in 16 cases (23%), while 18 patients (26%) had atlantoaxial impaction as judged by the Sakaguchi-Kauppi method. Subaxial subluxations and lateral atlantoaxial subluxations were found in 13 cases (19%) and 3/52 cases (6%), respectively, while 45 patients (65%) had subaxial disc space narrowing.
  
  
  CONCLUSIONS
  Cervical spine changes are common in patients with long lasting RA. They should be diagnosed and treated early to avoid complications. In our patient group no cervical spine surgery was performed, but at least 7 patients (10%) required further evaluation for possible surgery.
authors.affiliation: Rheumatism Foundation Hospital, Heinola, Finland.
authors.forename: M H
authors.initials: MH
authors.lastname: Neva
authors.forename: K
authors.initials: K
authors.lastname: Kaarela
authors.forename: M
authors.initials: M
authors.lastname: Kauppi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000097:blood / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011859:Radiography; D012217:Rheumatoid Factor / Q000097:blood; D013997:Time Factors
chemical_list: D012217:Rheumatoid Factor