Cervical spine involvement early in the course of rheumatoid arthritis.
OBJECTIVE
Cervical spine involvement in rheumatoid arthritis (RA) is considered a feature of long-standing disease. We describe two patients who presented with cervical symptoms as early features of RA.


METHODS
We report two RA cases with cervical spine involvement as early features and use MEDLINE to review the literature concerning the frequency and disease duration of this manifestation and its imaging with plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI).


RESULTS
An 80-year-old man with cervical myelopathy from a C1-C2 rheumatoid pannus underwent decompression surgery before development of peripheral synovitis from RA. A 63-year-old woman presented with neck pain and polyarthritis at RA diagnosis, with imaging that confirmed a C1-C2 rheumatoid pannus. Onset of cervical spine involvement in RA is generally after 10 years of disease duration, ranging from 3 months to 45 years after peripheral synovitis among patients with seropositive erosive RA. Occurring in 9-88% of RA patients, cervical spine involvement may result in cervical instability due to either mechanical compression or vascular impairment of the spinal cord. Bone erosions and atlanto-axial subluxation on standard radiographs are two major signs of cervical spine involvement in RA. MRI identifies earlier signs of RA and has a higher sensitivity in detecting bone erosions compared to conventional radiography.


CONCLUSIONS
Cervical spine involvement in RA is not an uncommon condition but is rare at early disease onset. Symptoms of cervical pain and myelopathy should prompt a thorough neurological examination accompanied by imaging.
Division of Rheumatology, Johns Hopkins University, Baltimore, MD; Department of Rheumatology, Klinik St. Katharinental, Diessenhofen, Switzerland.
Maria
M
Del Grande
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD; Department of Radiology, Ospedale Civico of Lugano, Lugano, Switzerland.
Filippo
F
Del Grande
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD.
John
J
Carrino
Division of Rheumatology, Johns Hopkins University, Baltimore, MD.
Clifton O
CO
Bingham
Division of Rheumatology, Johns Hopkins University, Baltimore, MD. Electronic address: glouie2@jhmi.edu.
Grant H
GH
Louie
D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis*; D002574:Cervical Vertebrae / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000209:etiology; D025241:Spondylarthritis / Q000175:diagnosis* / Q000209:etiology
Cervical spine; Imaging; MRI; Rheumatoid arthritis; Subluxation