Atlanto-axial subluxation in rheumatoid arthritis.

Mathews, John

doi:10.1136/ard.28.3.260

Cited by 96 publications

(43 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The present study confirms the previous observation that atlantoaxial subluxations of the cervical spine are associated with the extent of erosions in the peripheral joints (7,8,10,(27)(28)(29). However, our report is the first to present an estimation of the risk ratio for atlantoaxial subluxations, based on the radiographic scores in the peripheral joints during the first years of RA.…”

Section: Discussionsupporting

confidence: 75%

See 1 more Smart Citation

Early and extensive erosiveness in peripheral joints predicts atlantoaxial subluxations in patients with rheumatoid arthritis

Neva¹,

Isomäki²,

Hannonen³

et al. 2003

Arthritis & Rheumatism

View full text Add to dashboard Cite

Objective. To study the prevalence of cervical spine subluxations and predictive factors for atlantoaxial subluxations (including anterior atlantoaxial subluxation and atlantoaxial impaction, i.e., vertical subluxation) in patients with rheumatoid arthritis (RA) who were treated early and continuously with diseasemodifying antirheumatic drugs for 8-13 years.Methods. Radiographs of the cervical spine were obtained in 103 of 110 patients (the 110 surviving patients of the original 135-patient cohort) at their 8-13-year followup visits. The prevalence of cervical spine subluxations was determined. Demographic variables and the first 5-year serial data concerning disease course were analyzed in a logistic regression model to find predictive factors for atlantoaxial subluxations.Results. Atlantoaxial subluxations were found in 14 patients (14%), and 5 patients (5%) had subaxial subluxations. Older age at baseline, greater disease activity during the first 5 years, and early erosiveness in peripheral joints predicted the development of atlantoaxial subluxations. Patients who had >10% of the maximum possible radiographic damage (by Larsen score) in peripheral joints at 5 years were 15.9 times more likely to develop atlantoaxial subluxations at 8-13 years than patients whose peripheral joint damage remained <10% of the maximum.Conclusion. Compared with historical control RA cohorts, a lower prevalence of cervical spine destruction was found in the present group of patients. Rapid erosiveness in peripheral joints was the best predictor for atlantoaxial subluxations. Extensive erosiveness in peripheral joints should alert rheumatologists to the possible development of atlantoaxial subluxations in patients with RA.

show abstract

Section: Discussionsupporting

confidence: 75%

“…The rheumatoid disorders of the cervical spine are known to be associated with the extent of erosions in the peripheral joints and the HLA status, as well as with the presence of rheumatoid factor (RF) and rheumatoid nodules (6)(7)(8)(9)(10). Continuous disease activity predicts the development of erosions in peripheral joints (11,12).…”

mentioning

confidence: 99%

Early and extensive erosiveness in peripheral joints predicts atlantoaxial subluxations in patients with rheumatoid arthritis

Neva¹,

Isomäki²,

Hannonen³

et al. 2003

Arthritis & Rheumatism

View full text Add to dashboard Cite

show abstract

“…The destruction of the cervical spine has been associated with peripheral joint erosions, the presence of rheumatoid factor (RF) and subcutaneous nodules, and occasionally, with glucocorticoid therapy (4)(5)(6)(7). These findings reflect the fact that cervical spine disorders mainly occur in patients with severe RA.…”

mentioning

confidence: 71%

“…The number of erosions in peripheral joints, RF positivity, and the presence of subcutaneous nodules have been reported to correlate positively with cervical spine changes in RA (5)(6)(7)15). These changes reflect the systemic inflammatory activity, which is also the main target of DMARD therapy.…”

Section: Discussionmentioning

confidence: 99%

Combination drug therapy retards the development of rheumatoid atlantoaxial subluxations

Neva

Kauppi²,

Kautiainen³

et al. 2000

Arthritis & Rheumatism

View full text Add to dashboard Cite

Objective. To compare the efficacy of combination therapy with disease-modifying antirheumatic drugs (DMARDs) versus single therapy with DMARDs in the prevention of early cervical spine changes in patients with rheumatoid arthritis (RA).Methods. One hundred ninety-five patients with recent-onset RA (mean disease duration 8 months) were randomly assigned to receive a combination of DMARDs (sulfasalazine, methotrexate, hydroxychloroquine, and prednisolone) or a single DMARD with or without prednisolone. After 2 years of followup, cervical spine radiographs were taken of 176 of these patients (85 in the combination-therapy group and 91 in the single-therapy group). These radiographs were evaluated, and the findings were correlated with the therapy strategies as well as with peripheral joint destruction and clinical and laboratory variables describing the disease activity.Results. Anterior atlantoaxial subluxation (aAAS), atlantoaxial impaction (AAI; i.e., vertical subluxation), and subaxial subluxation (SAS) were found in only 6 (3.4%), 2 (1.1%), and 5 (2.8%) of the patients, respectively. Interestingly, none of the patients in the combination-therapy group had aAAS or AAI. The incidences of aAAS and AAI in the single-therapy group were 6.6% and 2.2%, respectively. SAS was present in 2 patients (2.2%) in the single-therapy group and in 3 patients (3.5%) in the combination-therapy group. The difference in the incidence of aAAS between the treatment groups was statistically significant (P ‫؍‬ 0.029). None of the patients with cervical spine changes achieved remission of RA during the study.Conclusion. In the present study, the incidence of cervical spine subluxations in patients treated with single-drug therapy was in accord with findings of previous studies. However, none of the patients in the combination-therapy group had aAAS or AAI. These findings suggest that early, aggressive combination-DMARD therapy with sulfasalazine, methotrexate, hydroxychloroquine, and prednisolone can prevent or retard the development of rheumatoid atlantoaxial disorders.

show abstract

“…There was a proliferation of the ependymal cells to such an extent that the central canal (canalis centralis) appeared to be obliterated. Mathews (1969) reported that AAD occurs in 25% of RA patients, nevertheless, the incidence varies with the selection of the patients and the criteria of AAD, as shown in Table 1. The incidence of the vertical type of A A D was reportedly 5.0% (Mathews 1969), 3.7% (Henderson 1975) and 22.2% by radiologic finding (Weissman et al 1982).…”

Section: Histologicalmentioning

confidence: 95%