[Rheumatoid arthritis with atlanto-axial subluxation. Pre-and postoperative symptoms, radiological findings and operative complications].
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.
Hartlev
Louise Brøndt
LB
Arhus Universitetshospital, Arhus Sygehus, Reumatologisk Afdeling, Arhus C. l_broendt@hotmail.com
Gudmundsdottir
Gudrun
G
Mosdal
Claus
C
Stengaard-Pedersen
Kristian
K
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