Atlanto-Axial Instability in Rheumatoid Arthritis

Abstract Introduction. Rheumatoid arthritis (RA) causes persistent synovitis which could lead to bone erosion, loss of joint cartilage and loose of ligament. In cervical spine this could cause instability, atlanto-axial joint subluxation and medulla spinalis compression. The aim of this paper was to establish the differences in clinical manifestations between patients with RA and atlanto-axial instability and patients with RA but without atlanto-axial instability. Methods. A total of 60 patients with a diagnosis of classical and definite rheumatoid arthritis according to the ACR criteria, divided into two groups, participated in this study since 1988. Thirty patients with RA and detected atlanto-axial instability, with expressed cervico-occipital symptomatology participated in the first group. The second group comprised 30 patients with RA but without detected atlanto-axial instability. All patients underwent native and functional x-ray of cervical spine in neutral and lateral position, in flexion and extension as well as CT images. MRI was realized in majority of patients. For assessment of rheumatoid arthritis activity, all patients underwent DAS 28 score test as well as laboratory immunologic tests: RF, CRP and anti-CCR. Statistical analysis was made with appropriate statistical methods. Results. The mean patients’ age in the RA group and atlanto-axial instability was 56.9±12.2 years, which was insignificantly smaller than the mean participants’ age from the group with RA. Females dominated in both groups. The mean time duration of the disorder in the RA group and atlanto-axial instability was 17.9±7.8 years, while in the group with RA only it was 6.9±4.2 years. The high SE, RF, anti-CCR as well as DAS28 values were significantly more frequently present in patients with atlanto-axial subluxation (AAS). The results from the investigation showed that the joint deformities as well as the neurologic symptoms were registered significantly more frequently in the patient group with RA and AAS. Conclusion. In patients with long-lasting active RA due to persistent synovitis at the level of the atlanto-axial joint comes to subluxation of the same joint which could cause significant neurologic symptoms.