title: High mortality in patients with rheumatoid arthritis and atlantoaxial subluxation.
abstract: OBJECTIVE
  To study relationships between atlantoaxial subluxation (AAS) and total mortality in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  Radiological reports and clinical files of patients with RA were reviewed for the presence of cervical spine involvement verified by cervical radiographs.
  
  
  RESULTS
  Among 241 patients with cervical radiographs, anterior AAS > or = 4 mm was found in 5% [95% confidence interval (CI) 2-8] of patients. Vertical and posterior subluxations were found in 1.4 and 0.5%, respectively. The mean observation time from RA diagnosis to AAS was 3.9 years. Patients with AAS had 8 times higher mortality than patients without AAS (95% CI 3-25). According to the death certificate, the patients died from cancer, stroke, and myocardial infarction. Cervical spine disorder was not mentioned on the death certificate. However, an autopsy was not performed.
  
  
  CONCLUSIONS
  We found high mortality in RA patients with AAS. AAS in the cervical spine developed relatively early in the course of the disease. Analyses adjusted for seropositivity, erosiveness, and glucocorticosteroids did not reduce the mortality rate ratio. Our results underline the need for careful evaluation of patients with RA with respect to development of AAS.
authors.affiliation: Institute of Clinical Medicine, University of Tromsø, and Department of Rheumatology, University Hospital of Tromsø, Norway. tove.riise@rito.no
authors.forename: T
authors.initials: T
authors.lastname: Riise
authors.forename: B K
authors.initials: BK
authors.lastname: Jacobsen
authors.forename: J T
authors.initials: JT
authors.lastname: Gran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality*; D001268:Atlanto-Axial Joint; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011859:Radiography; D015996:Survival Rate