title: [Rheumatoid arthritis with atlanto-axial subluxation. Pre-and postoperative symptoms, radiological findings and operative complications].
abstract: BACKGROUND
  The aim of the study was to study pre- and postoperative symptoms, radiological findings and operative complications in rheumatoid arthritis (RA) patients, operated in the atlantoaxial joint.
  
  
  METHODS
  A retrospective study of 31 RA patients (24 women, seven men) operated for anterior atlantoaxial subluxation (aAAS) at the Neurosurgical Department, Aarhus University Hospital, in the period of 1993-2003. Information was obtained retrospectively from the patients charge.
  
  
  RESULTS
  Mean age at RA debut was 38 years (16-69 yrs), and neck symptoms were seen after a mean time of 15 years (0-39 yrs) of illness. Radiological examination at this time showed irreversible atlantoaxial changes, and operation was performed within 0-9 years (mean 1.6 yrs). The patients were characterized by high disease activity: C-reactive protein, anaemia, positive IgM-rheumatoid factor (84%), and progressive radiological changes in the peripheral joints. All patients were treated with DMARDs (disease modifying anti rheumatic drugs). Neck pain (100%) and neurological symptoms/manifestations (87%) were seen preoperatively. After operation symptoms were relieved in 68% of the patients, while 22% were unchanged, and 10% had worsened. Postoperative complications included cardiac death, dislocation of the cervical spine, fracture of arcus atlantis, hemiparesis, dysphagia, bed sores and infection of the surgical scar (29%).
  
  
  CONCLUSIONS
  Neck symptoms were seen after 15 years of illness, and within the following 1.6 years patients were operated for aAAS. After the operation most of the patients (68%) had relief from symptoms, while 29% had postoperative complications, including cardiac death, dislocation of the cervical spine, fracture of arcus atlantis, hemiparesis, dysphagia, bed sores and infection in the surgical scar.
authors: Arhus Universitetshospital, Arhus Sygehus, Reumatologisk Afdeling, Arhus C. l_broendt@hotmail.com
authors: Louise Brøndt
authors: LB
authors: Hartlev
authors: Gudrun
authors: G
authors: Gudmundsdottir
authors: Claus
authors: C
authors: Mosdal
authors: Kristian
authors: K
authors: Stengaard-Pedersen
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D004204:Joint Dislocations; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies