Maria Del Grande1, Filippo Del Grande2, John Carrino3, Clifton O Bingham4, Grant H Louie5. 1. Division of Rheumatology, Johns Hopkins University, Baltimore, MD; Department of Rheumatology, Klinik St. Katharinental, Diessenhofen, Switzerland. 2. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD; Department of Radiology, Ospedale Civico of Lugano, Lugano, Switzerland. 3. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD. 4. Division of Rheumatology, Johns Hopkins University, Baltimore, MD. 5. Division of Rheumatology, Johns Hopkins University, Baltimore, MD. Electronic address: glouie2@jhmi.edu.
Abstract
OBJECTIVES: Cervical spine involvement in rheumatoid arthritis (RA) is considered a feature of long-standing disease. We describe two patients who presented with cervical symptoms as early features of RA. METHODS: We report two RA cases with cervical spine involvement as early features and use MEDLINE to review the literature concerning the frequency and disease duration of this manifestation and its imaging with plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI). RESULTS: An 80-year-old man with cervical myelopathy from a C1-C2 rheumatoid pannus underwent decompression surgery before development of peripheral synovitis from RA. A 63-year-old woman presented with neck pain and polyarthritis at RA diagnosis, with imaging that confirmed a C1-C2 rheumatoid pannus. Onset of cervical spine involvement in RA is generally after 10 years of disease duration, ranging from 3 months to 45 years after peripheral synovitis among patients with seropositive erosive RA. Occurring in 9-88% of RA patients, cervical spine involvement may result in cervical instability due to either mechanical compression or vascular impairment of the spinal cord. Bone erosions and atlanto-axial subluxation on standard radiographs are two major signs of cervical spine involvement in RA. MRI identifies earlier signs of RA and has a higher sensitivity in detecting bone erosions compared to conventional radiography. CONCLUSIONS: Cervical spine involvement in RA is not an uncommon condition but is rare at early disease onset. Symptoms of cervical pain and myelopathy should prompt a thorough neurological examination accompanied by imaging.
OBJECTIVES: Cervical spine involvement in rheumatoid arthritis (RA) is considered a feature of long-standing disease. We describe two patients who presented with cervical symptoms as early features of RA. METHODS: We report two RA cases with cervical spine involvement as early features and use MEDLINE to review the literature concerning the frequency and disease duration of this manifestation and its imaging with plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI). RESULTS: An 80-year-old man with cervical myelopathy from a C1-C2 rheumatoid pannus underwent decompression surgery before development of peripheral synovitis from RA. A 63-year-old woman presented with neck pain and polyarthritis at RA diagnosis, with imaging that confirmed a C1-C2 rheumatoid pannus. Onset of cervical spine involvement in RA is generally after 10 years of disease duration, ranging from 3 months to 45 years after peripheral synovitis among patients with seropositive erosive RA. Occurring in 9-88% of RA patients, cervical spine involvement may result in cervical instability due to either mechanical compression or vascular impairment of the spinal cord. Bone erosions and atlanto-axial subluxation on standard radiographs are two major signs of cervical spine involvement in RA. MRI identifies earlier signs of RA and has a higher sensitivity in detecting bone erosions compared to conventional radiography. CONCLUSIONS: Cervical spine involvement in RA is not an uncommon condition but is rare at early disease onset. Symptoms of cervical pain and myelopathy should prompt a thorough neurological examination accompanied by imaging.
Authors: Marina Carotti; Fausto Salaffi; Marco Di Carlo; Francesco Sessa; Andrea Giovagnoni Journal: Skeletal Radiol Date: 2018-09-11 Impact factor: 2.199
Authors: L Ellingwood; O Schieir; M F Valois; S J Bartlett; L Bessette; G Boire; G Hazlewood; C Hitchon; E C Keystone; D Tin; C Thorne; V P Bykerk; J E Pope Journal: ACR Open Rheumatol Date: 2019-10-21