title: EVALUATION OF THE CERVICAL SPINE AMONG PATIENTS WITH RHEUMATOID ARTHRITIS.
abstract: OBJECTIVE
  To evaluate the prevalence of cervical spine abnormalities among patients with rheumatoid arthritis and correlate the imaging findings with the clinical state.
  
  
  METHODS
  A cross-sectional study on 35 patients was carried out at the School of Medicine of the Federal University of Goiás (UFG) in 2004. The following were evaluated: age, use of medications and the clinical picture of pain and neurological characteristics. The erythrocyte sedimentation rate (ESR) and rheumatoid factor were tested, and radiographs of the cervical spine were produced in anteroposterior, lateral and dynamic views. To evaluate the influence of the variables on the emergence of instabilities, univariate and multivariate logistic regression tests were used (p < 0.05).
  
  
  RESULTS
  Among the 35 patients evaluated, 13 (37.1%) presented a stable cervical spine. Out of the 22 patients with instability, six presented more than one type. Atlantoaxial instability was found in 15 patients, with a mean anterior atlantodental distance of 3.40 mm in the neutral lateral radiographic view and 6.54 mm in the lateral view with flexion. Basilar invagination was found in five patients and subaxial subluxation in seven patients. Two thirds of the asymptomatic patients had instabilities. Bicipital hyperreflexia presented statistically significant correlations with atlantoaxial instability (p = 0.024) and subaxial instability (p = 0.01). Age at diagnosis correlated with subaxial instability (p = 0.02).
  
  
  CONCLUSIONS
  The prevalence of cervical instability was 62.9 % (22/35). The most frequent instabilities were: atlantoaxial subluxation (42.9 %), subaxial subluxation (20%) and basilar invagination (14.3%). The correlation between instabilities and clinical signs and symptoms was poor. The patients with subaxial subluxation presented disease onset at a younger age. Dynamic radiography was important for diagnosing atlantoaxial subluxation.
authors.affiliation: MSc from UnB. Attending Physician in the Spinal Surgery Service, DOT-HC, Federal University of Goiás (UFG).
authors.forename: André Luiz
authors.initials: AL
authors.lastname: Passos Cardoso
authors.affiliation: PhD from USP. Titular Professor of Rheumatology in the Department of Clinical Medicine, School of Medicine, Federal University of Goiás (UFG).
authors.forename: Nilzio Antonio
authors.initials: NA
authors.lastname: Da Silva
authors.affiliation: Auxiliary Professor and Head of the Spinal Surgery Service, DOT-HC, Federal University of Goiás (UFG).
authors.forename: Sérgio
authors.initials: S
authors.lastname: Daher
authors.affiliation: MSc from UnB. Auxiliary Professor, DOT-HC, Federal University of Goiás (UFG).
authors.forename: Frederico Barra
authors.initials: FB
authors.lastname: De Moraes
authors.affiliation: Attending Physician in the Rheumatology Service, Department of Clinical Medicine, School of Medicine, Federal University of Goiás (UFG).
authors.forename: Humberto Franco
authors.initials: HF
authors.lastname: Do Carmo
keywords: Cervical vertebrae; Rheumatoid arthritis; Spine