Clinical and radiographic analysis of patients with cervical subluxations in rheumatoid arthritis / 中华风湿病学杂志

ABSTRACT

Objective To investigate the clinical and radiographic features of rheumatoid arthritis (RA) patients with cervical subluxations.Methods The clinical, laboratory and imaging data of 68 RA patients who were hospitalized to our hospital because of cervical syndrome were retrospectively reviewed.The patients were divided into two groups depend based on whether cervical spine subluxations presented or not.Mann-Whitney U test, t test and Person correlation, x2 test were used for statistical analysis.Results This study confirmed the high frequency (11.6％, 39/335) of radiological cervical subluxations in RA patients.The nNeck pain was a common symptom, accounting for 87％ (34/39).Other symptoms included limb numbness 59％ (23/39).The rate of positive C-reactive protein (CRP) in the subluxation group was both significantly higher than that of the non-subluxation group [89％(24/27) vs 59％(16/27),x2=6.17, P＜0.01].Anterior atlantoaxial subluxation (AAS) was the most common form, accounting for 95％(37/39) of all cervical subluxations,followed by vertical subluxation (VS), accounting for 18％ (7/39).Subaxial subluxation (SAS) of the lower cervical vertebrae was less common (5.1％).The ratio of bone destruction, spinal stenosis, spinal cord compression in image findings of the subluxation group was significantly higher than that of the non-subluxation group (x2=7.96, x2=6.12, x2=4.89, P＜0.05).But more hyperostosis and osteosclerosis feature of the non-subluxation group could be observed more hyperostosis and osteosclerosis feature (x2=6.21, P＜0.05).PADI correlated with ADI (r=-0.588, P=0.015).Conclusion This study confirms the high frequency of radiological cervical involvement in patients with RA.AAS is the most common form of cervical involvement and may occur either independently or concomitantly with cranial settling and subaxial subluxation.