title: Atlantoepistrophic magnetic resonance imaging involvement in early rheumatoid arthritis: an aggressive tight control therapy not fully arresting the disease.
abstract: OBJECTIVE
  Rheumatoid arthritis (RA) is the most common inflammatory disorder affecting the cervical spine. The purpose of this study was to characterize the atloaxial involvement with magnetic resonance imaging (MRI) in patients with early RA at the moment of diagnosis and after 18 months of a tight control therapy.
  
  
  METHODS
  Twenty consecutive patients with early RA without cervical symptoms and 20 healthy controls were enrolled. The patients underwent unenhanced and enhanced gadolinium MRI study of the upper cervical spine at diagnosis and after 18 months of therapy. The presence of pannus tissue at MRI was considered active synovitis.
  
  
  RESULTS
  Five (25%) of the 20 patients presented craniocervical involvement with active synovitis at MRI. At onset, patients with cervical involvement presented higher levels of erythrocyte sedimentation rate, a higher swollen joint count, and a higher Disease Activity Score in 44 joints level. All 5 patients (100%) with cervical involvement presented already peripheral erosions. After 18 months, 1 of 5 patients with atloepistrophic synovial involvement at baseline presented complete regression of the enhancement of synovial periodontoid process, and 1 presented a decrease of this enhancement. None of the patients developed erosive process at the odontoid. The only patient with complete regression of the enhancement presented a very early disease (<3 months).
  
  
  CONCLUSIONS
  Our study demonstrates involvement of the atloaxial junction in 25% of early RA patients, in particular in patients with active and erosive arthritis. An early diagnosis and aggressive treatment with a combination therapy, aiming for remission, does not always reduce atlantoaxial synovitis.
authors.affiliation: School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Zoli
authors.forename: Silvia
authors.initials: S
authors.lastname: Bosello
authors.forename: Nicola
authors.initials: N
authors.lastname: Magarelli
authors.forename: Graziella
authors.initials: G
authors.lastname: D'Antona
authors.forename: Rosanna
authors.initials: R
authors.lastname: Amelia
authors.forename: Annalaura
authors.initials: A
authors.lastname: Fedele
authors.forename: Giusy
authors.initials: G
authors.lastname: Peluso
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bonomo
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferraccioli
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000473:pathology*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003287:Contrast Media; D004359:Drug Therapy, Combination; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D011859:Radiography; D013585:Synovitis / Q000175:diagnosis* / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine