[Rheumatoid arthritis at the cervical spine -- an underestimated problem].
OBJECTIVE
The involvement of the cervical spine in rheumatoid arthritis can be essential regarding prognosis and mortality. The cervical myelopathy due to pannus formation and/or subluxation can be fatal. Aim of this study was to demonstrate the possible changes seen by MRI, and to establish a risk-profile for the individual patient.


METHODS
Within a period of 24 months 214 patients with active RA were included. Clinical and laboratory data were obtained and plain radiographs of the cervical spine were taken. In patients with pathological findings on X-ray an MRI was performed (36 patients).


RESULTS
Within the group of 214 patients 36 were identified to get an cervical spine MRI. In all cases the MRI showed significant changes: in 7 (19.5 %) pannus surrounded the dens, with additional erosions in one patient (2.7 %). In 25 (69.5 %) atlanto-axial-subluxation was present, 7 (19.5 %) showed a spondylodiscitis below C2. In 10 (27.8 %) a cervical myelopathy due to pannus or subluxation was present. There was no correlation of the MRI-results with symptoms and findings by examination. The patients with cervical spine disease were in all stages of RA. The majority was rheumatoid-factor positive. 5 out of 10 patients with cervical myelopathy showed neurological deficits: 3 patients died in consequence of neural compression, 2 patients underwent surgery successfully.


CONCLUSIONS
The early detection of a cervical spine involvement in RA is essential to avoid possibly fatal complications. The only reliable method to achieve this goal has to include radiographic diagnostic including MRI of the cervical spine. Only this approach can answer the question of the right time-point for surgery. In daily clinical practice the cervical-spine involvement in RA is still underestimated.
Schwarz-Eywill
M
M
I. Medizinische Klinik, Schwerpunkt Rheumatologie/Klinische Immunologie, Klinikum Dresden-Friedrichstadt, Dresden.
Friedberg
R
R
Stösslein
F
F
Unger
L
L
Nüsslein
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000401:mortality / Q000473:pathology*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D015299:Discitis / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012217:Rheumatoid Factor / Q000097:blood; D012307:Risk Factors; D013117:Spinal Cord Compression / Q000209:etiology / Q000401:mortality; D013118:Spinal Cord Diseases / Q000473:pathology; D025241:Spondylarthritis / Q000401:mortality / Q000473:pathology*
D012217:Rheumatoid Factor