Husham A Al-Daoseri1, Mubder A Mohammed Saeed2, Rafal A Ahmed3. 1. Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Basrah University, Basrah, Iraq. 2. Department of Surgery, Faculty of Medicine, Basrah University, Basrah, Iraq. 3. Abu Ghuraib General Hospital, Iraq.
Abstract
AIM OF THE WORK: This study analysed the prevalence of cervical spine instability in Rheumatoid Arthritis (RA) patients following at a single centre in Basrah. PATIENTS AND METHODS: Data were collected directly from patients through cervical spine examinations. Each patient was sent for dynamic (flexion and extension) lateral cervical radiographic imaging to assess the presence of atlantoaxial subluxation (AAS), superior migration of the odontoid (SMO) and sub-axial subluxation (SAS). Patients with positive radiographic findings were sent for MRI scans of the cervical spine to assess neurological compression. RESULTS: The prevalence rate of cervical spine instability in RA was 15/203 (7.4%) of the total sample, occurring primarily in patients of 37-65 years old (mean: 48 ± 8.9 years), were 3/15 (20%) aymptomatic. The majority (60%) being at the moderate stage of the disease activity (using a Clinical Disease Activity Index [CDAI). In terms of type of cervical spine involvement, isolated AAS was found to have the highest occurrence (73.3%), followed by combined SAS and SMO (13.3%), combined AAS and SMO (6.7%), and combined AAS and SAS (6.7%). A significant relationship was found between the type of cervical spine involvement in RA and a disease onset duration, disease activity, body mass index and peripheral erosion with P value < 0.05. CONCLUSION: Cervical spine subluxation in RA patients may be asymptomatic It is therefore essential to obtain a dynamic radiographic image of the cervical spine in order to diagnose cervical spine involvement and protect the patient from severe outcomes.The clinical trial registration number included in a the official document from Ministry of Higher Education and Science Research/Basrah University/Faculty of Medicine to Basrah Health Directorate/Research and Development Division is 72/3588 in 7 Jan 2017.
AIM OF THE WORK: This study analysed the prevalence of cervical spine instability in Rheumatoid Arthritis (RA) patients following at a single centre in Basrah. PATIENTS AND METHODS: Data were collected directly from patients through cervical spine examinations. Each patient was sent for dynamic (flexion and extension) lateral cervical radiographic imaging to assess the presence of atlantoaxial subluxation (AAS), superior migration of the odontoid (SMO) and sub-axial subluxation (SAS). Patients with positive radiographic findings were sent for MRI scans of the cervical spine to assess neurological compression. RESULTS: The prevalence rate of cervical spine instability in RA was 15/203 (7.4%) of the total sample, occurring primarily in patients of 37-65 years old (mean: 48 ± 8.9 years), were 3/15 (20%) aymptomatic. The majority (60%) being at the moderate stage of the disease activity (using a Clinical Disease Activity Index [CDAI). In terms of type of cervical spine involvement, isolated AAS was found to have the highest occurrence (73.3%), followed by combined SAS and SMO (13.3%), combined AAS and SMO (6.7%), and combined AAS and SAS (6.7%). A significant relationship was found between the type of cervical spine involvement in RA and a disease onset duration, disease activity, body mass index and peripheral erosion with P value < 0.05. CONCLUSION: Cervical spine subluxation in RA patients may be asymptomatic It is therefore essential to obtain a dynamic radiographic image of the cervical spine in order to diagnose cervical spine involvement and protect the patient from severe outcomes.The clinical trial registration number included in a the official document from Ministry of Higher Education and Science Research/Basrah University/Faculty of Medicine to Basrah Health Directorate/Research and Development Division is 72/3588 in 7 Jan 2017.
Authors: Hoan Vu Nguyen; Steven C Ludwig; Jeffery Silber; Daniel E Gelb; Paul A Anderson; Lawrence Frank; Alexander R Vaccaro Journal: Spine J Date: 2004 May-Jun Impact factor: 4.166
Authors: Fina A S Kurreeman; Leonid Padyukov; Rute B Marques; Steven J Schrodi; Maria Seddighzadeh; Gerrie Stoeken-Rijsbergen; Annette H M van der Helm-van Mil; Cornelia F Allaart; Willem Verduyn; Jeanine Houwing-Duistermaat; Lars Alfredsson; Ann B Begovich; Lars Klareskog; Tom W J Huizinga; Rene E M Toes Journal: PLoS Med Date: 2007-09 Impact factor: 11.069