Clinical and radiological features of atlantoaxial joints in rheumatoid arthritis

Babić-Naglić, Đurđica; Potočki, Kristina; Ćurković, Božidar

doi:10.1007/s003930050170

Cited by 10 publications

(8 citation statements)

References 16 publications

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“…Only one study of RA patients with CS disease showed correlation between clinical symptoms, neurological manifestations and radiological damage. 80 In the absence of clinical symptoms, if AAS or SAS or atlanto-axial impaction are present in the radiological assessment, then attention is required for surgical consultation. 15 , 81 …”

Section: Discussionmentioning

confidence: 99%

A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review

Drosos

Pelechas

Georgiadis

2021

MJR

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Background: Rheumatoid arthritis (RA) may affect any diarthrodial joint with a predilection on the peripheral skeleton in a symmetrical manner. When the axial skeleton is affected, it is the cervical spine (CS) that gets involved with potentially detrimental effects, if not treated promptly. Case: A 60-year-old female suffering from RA presented with severe neck pain and stiffness, difficulty of standing and walking with brisk tendon reflexes, Babinski sign positive, and clonus. Despite the high inflammatory markers and high titres of autoantibodies (rheumatoid factor and anticitrullinated protein antibodies), she never received proper treatment. She was using only paracetamol and non-steroidal anti-inflammatory drugs. Conventional radiography (CR) of CS showed extensive degenerative changes affecting the C3–C5 vertebral level. Magnetic Resonance Imaging of the neck showed sub-axial subluxation (SAS) and spinal cord compression at C3 level, and to a lesser extent, in other levels. A multi-level cervical laminectomy and spinal cord decompression were deployed with good results. To this end, literature review was performed until September 2020 and showed that the frequency of radiological findings varies substantially, ranging between 0,7–95% in different studies. The most common radiological feature is the atlanto-axial subluxation (AAS) followed by SAS. Because CS involvement can often be clinically asymptomatic, its assessment should not be forgotten by physicians and should be assessed using CR, which is an easy-to-perform technique and gives important information as a screening tool. On the other hand, RA patients need to be treated in a prompt and efficient manner in order to avoid any potentially fatal complications.

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Section: Discussionmentioning

confidence: 99%

A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review

Drosos

Pelechas

Georgiadis

2021

MJR

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“…Any patient with risk factors for development of ATS (rheumatoid arthritis, Down syndrome, congenital scoliosis, osteogenesisimperfecta, ankylosing spondylitis, neurofibromatosis) merits urgent radiographic and surgical evaluation [41].…”

Section: Miscellaneousmentioning

confidence: 99%

Rheumatologic emergencies

Gutiérrez-González

2015

Clin Rheumatol

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Rheumatological conditions can sometimes present as emergencies. These can occur due to the disease process or infection; contrary to what many people think, rheumatologic emergencies like a pain, rheumatic crisis, or attack gout do not compromise the patient's life. This article mentioned only true emergencies: catastrophic antiphospholipid syndrome (cAPS), kidney-lung syndrome, central nervous system (CNS) vasculitis, anti-Ro syndrome (neonatal lupus), and macrophage activation syndrome (MAS). The management of above emergencies includes critical care, immunosuppression when indicated, and use of a diagnostic flowchart as well as fast laboratory profile for making decisions. Anticoagulants have to be used in the management of antiphospholipid syndrome. A good understanding of these conditions is of paramount importance for proper management.

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“…28 Areal bone mineral densities (measured in g/cm 2 ) were obtained along the occipital landmarks of interest (i.e., EOP, SNL, and INL) with a software scan setting for the forearm and subregional analyses of square regions of interest corresponding to 0.81 cm 2 . Values for regional volumetric bone mineral density (vBMD; measured in g/cm 3 ) were calculated by dividing the areal BMD of each region by the thickness of bone in that region as measured by calipers.…”

Section: Occipital Measurements and Bone Quality Analysismentioning

confidence: 99%

Densitometric comparison of 3 occipital regions for suitability of fixation

Das

Newcomb

Gaudin

et al. 2016

SPI

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OBJECTIVE Atlantooccipital fixation is an important technique in the treatment of upper cervical spine instability. Important considerations for implant devices are obtrusiveness and propagation of torque through the device caused by cervical rotation. The authors evaluated the feasibility of 3 regions of the occiput as sites for occipitocervical fixation by examining bone mineral density at these locations. METHODS Unembalmed occiputs of 9 male and 4 female cadavers were used (mean age at time of death was 61.6 years, range 36–68 years). Studies were undertaken using caliper measurements and dual-energy x-ray absorptiometry of the superior nuchal line (SNL), the external occipital protuberance (EOP), and the inferior nuchal line (INL). RESULTS Data indicate that the bone at the INL has a similar volumetric bone density as the bone at the SNL, despite having half the thickness. Also, the volumetric bone density increases laterally along the nuchal lines. CONCLUSIONS Most hardware fixation is centered on stabilization at the EOP and the SNL. On the basis of these radiological results, the INL shows promise as a potential alternative site for screw placement in occipitocervical fixation.

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Clinical and radiological features of atlantoaxial joints in rheumatoid arthritis

Cited by 10 publications

References 16 publications

A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review

A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review

Rheumatologic emergencies

Densitometric comparison of 3 occipital regions for suitability of fixation

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