Cervical Spine Disease in Rheumatoid Arthritis: Incidence, Manifestations, and Therapy

Overview

Journal Curr Rheumatol Rep

Publisher Current Science

Specialty Rheumatology

Date 2015 Feb 10

PMID 25663179

Citations 10

Authors

Han Jo Kim

Venu M Nemani

K Daniel Riew

Richard Brasington

Affiliations

Soon will be listed here.

Abstract

Cervical spine involvement in patients with rheumatoid arthritis (RA) and other inflammatory arthropathies is common. While the radiographic features can be dramatic in untreated disease, patients may remain asymptomatic making treatment decisions challenging. Further, subtle clinical presentations can belie serious myelopathy because peripheral joint involvement can make interpreting the physical exam difficult. While new pharmacologic therapies have drastically reduced the morbidity of the widespread joint destruction that occurs in RA, patients remain at risk for symptomatic occipitocervical, atlantoaxial, or subaxial instability causing myelopathy, deformity, and premature death. In this review, we discuss the clinical presentation of RA patients with cervical spine disease as well as the indications and outcomes of surgical treatment.

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References

Matsunaga S, Sakou T, Onishi T, Hayashi K, Taketomi E, Sunahara N . Prognosis of patients with upper cervical lesions caused by rheumatoid arthritis: comparison of occipitocervical fusion between c1 laminectomy and nonsurgical management. Spine (Phila Pa 1976). 2003; 28(14):1581-7; discussion 1587. View

Pellicci P, Ranawat C, Tsairis P, BRYAN W . A prospective study of the progression of rheumatoid arthritis of the cervical spine. J Bone Joint Surg Am. 1981; 63(3):342-50. View

Kaito T, Ohshima S, Fujiwara H, Makino T, Yonenobu K . Predictors for the progression of cervical lesion in rheumatoid arthritis under the treatment of biological agents. Spine (Phila Pa 1976). 2013; 38(26):2258-63. DOI: 10.1097/BRS.0000000000000066. View

Yurube T, Sumi M, Nishida K, Miyamoto H, Kohyama K, Matsubara T . Accelerated development of cervical spine instabilities in rheumatoid arthritis: a prospective minimum 5-year cohort study. PLoS One. 2014; 9(2):e88970. PMC: 3928338. DOI: 10.1371/journal.pone.0088970. View

Peppelman W, Kraus D, Donaldson 3rd W, Agarwal A . Cervical spine surgery in rheumatoid arthritis: improvement of neurologic deficit after cervical spine fusion. Spine (Phila Pa 1976). 1993; 18(16):2375-9. DOI: 10.1097/00007632-199312000-00001. View

Althoff B, Goldie I . Cervical collars in rheumatoid atlanto-axial subluxation: a radiographic comparison. Ann Rheum Dis. 1980; 39(5):485-9. PMC: 1000591. DOI: 10.1136/ard.39.5.485. View

Delamarter R, Bohlman H . Postmortem osseous and neuropathologic analysis of the rheumatoid cervical spine. Spine (Phila Pa 1976). 1994; 19(20):2267-74. DOI: 10.1097/00007632-199410150-00004. View

Kauppi M, Neva M . Sensitivity of lateral view cervical spine radiographs taken in the neutral position in atlantoaxial subluxation in rheumatic diseases. Clin Rheumatol. 1999; 17(6):511-4. DOI: 10.1007/BF01451289. View

Neva M, Hakkinen A, Makinen H, Hannonen P, Kauppi M, Sokka T . High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery. Ann Rheum Dis. 2005; 65(7):884-8. PMC: 1798218. DOI: 10.1136/ard.2005.042135. View

10.

Aaltonen K, Virkki L, Malmivaara A, Konttinen Y, Nordstrom D, Blom M . Systematic review and meta-analysis of the efficacy and safety of existing TNF blocking agents in treatment of rheumatoid arthritis. PLoS One. 2012; 7(1):e30275. PMC: 3260264. DOI: 10.1371/journal.pone.0030275. View

11.

Reiter M, Boden S . Inflammatory disorders of the cervical spine. Spine (Phila Pa 1976). 1999; 23(24):2755-66. DOI: 10.1097/00007632-199812150-00017. View

12.

Riew K, Hilibrand A, Palumbo M, Sethi N, Bohlman H . Diagnosing basilar invagination in the rheumatoid patient. The reliability of radiographic criteria. J Bone Joint Surg Am. 2001; 83(2):194-200. DOI: 10.2106/00004623-200102000-00006. View

13.

Halla J, Hardin J, Vitek J, Alarcon G . Involvement of the cervical spine in rheumatoid arthritis. Arthritis Rheum. 1989; 32(5):652-9. DOI: 10.1002/anr.1780320522. View

14.

Boden S, Dodge L, Bohlman H, Rechtine G . Rheumatoid arthritis of the cervical spine. A long-term analysis with predictors of paralysis and recovery. J Bone Joint Surg Am. 1993; 75(9):1282-97. DOI: 10.2106/00004623-199309000-00004. View

15.

McRae D, BARNUM A . Occipitalization of the atlas. Am J Roentgenol Radium Ther Nucl Med. 1953; 70(1):23-46. View

16.

Del Grande M, Del Grande F, Carrino J, Bingham 3rd C, Louie G . Cervical spine involvement early in the course of rheumatoid arthritis. Semin Arthritis Rheum. 2014; 43(6):738-44. DOI: 10.1016/j.semarthrit.2013.12.001. View

17.

Sugita S, Chikuda H, Kadono Y, Ohtsu H, Takeshita K, Nishino J . Clinical characteristics of rheumatoid arthritis patients undergoing cervical spine surgery: an analysis of National Database of Rheumatic Diseases in Japan. BMC Musculoskelet Disord. 2014; 15:203. PMC: 4071212. DOI: 10.1186/1471-2474-15-203. View

18.

Agarwal A, Peppelman Jr W, Kraus D, EISENBEIS Jr C . The cervical spine in rheumatoid arthritis. BMJ. 1993; 306(6870):79-80. PMC: 1676683. DOI: 10.1136/bmj.306.6870.79. View

19.

Kauppi M, Neva M, Laiho K, Kautiainen H, Luukkainen R, Karjalainen A . Rheumatoid atlantoaxial subluxation can be prevented by intensive use of traditional disease modifying antirheumatic drugs. J Rheumatol. 2009; 36(2):273-8. DOI: 10.3899/jrheum.080429. View

20.

Menezes A, VanGilder J, Clark C . Odontoid upward migration in rheumatoid arthritis. An analysis of 45 patients with "cranial settling". J Neurosurg. 1985; 63(4):500-9. DOI: 10.3171/jns.1985.63.4.0500. View