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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Aaltonen KJ, Virkki LM, Malmivaara A, Konttinen YT, Nordström DC, 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. doi:10.1371/journal.pone.0030275. Epub 2012 Jan 17. Review.
Takashi Kaito MD, Shirou Ohshima MD. Predictors for the progression of cervical lesion in rheumatoid arthritis under the treatment of biological agents. Spine. 2013;38(26):2258–63.
Agarwal AK, Peppelman Jr WC, Kraus DR, Eisenbeis Jr CH. The cervical spine in rheumatoid arthritis. BMJ. 1993;306(6870):79–80.
Halla JT, Hardin JG, Vitek J, Alarcon GS. Involvement of the cervical spine in rheumatoid arthritis. Arthritis Rheum. 1989;32:652–9.
Kauppi MJ, Neva MH, Laiho K, Kautiainen H, Luukkainen R, Karjalainen A, et al. Rheumatoid atlantoaxial subluxation can be prevented by intensive use of traditional disease modifying antirheumatic drugs. J Rheumatol. 2009;36(2):273–8.
Neva MH, Häkkinen A, Mäkinen 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. 2006;65(7):884–8. Epub 2005 Nov 3.
Del Grande M, Del Grande F, Carrino J, Bingham III CO, Louie GH. 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. Epub 2013 Dec 12.
Yurube T, Sumi M et al. Accelerated development of cervical spine instabilities in rheumatoid arthritis: a prospective minimum 5-year cohort study PLOS 2014
Menezes AH, VanGilder JC, Clark CR, el-Khoury G. Odontoid upward migration in rheumatoid arthritis. An analysis of 45 patients with “cranial settling”. J Neurosurg. 1985;63(1):500–9.
McRae DL, Barnum AS. Occipitalization of the atlas. Am J Roentgenol Radium Ther Nucl Med. 1953;70:23–46.
Sugita et al. Clinical characteristics of rheumatoid arthritis patients undergoing cervical spine surgery: an analysis of National Database of Rheumatic Diseases in Japan BMC Musculoskeletal Disorders 2014, 15:203
Delamarter RB, Bohlman HH. Postmortem osseous and neuropathologic analysis of the rheumatoid cervical spine. Spine (Phila Pa 1976). 1994;19(20):2267–74.
Althoff B, Goldie IF. Cervical collars in rheumatoid atlanto-axial subluxation: a radiographic comparison. Ann Rheum Dis. 1980;39(5):485–9.
Pellicci PM, Ranawat CS, Tsairis P, Bryan WJ. A prospective study of the progression of rheumatoid arthritis of the cervical spine. J Bone Joint Surg Am. 1981;63(3):342–50.
Matsunaga S, Sakou T, Onishi T, Hayashi K, Taketomi E, Sunahara N, et al. 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.
Kauppi M, Neva MH. Sensitivity of lateral view cervical spine radiographs taken in the neutral position in atlantoaxial subluxation in rheumatic diseases. Clin Rheumatol. 1998;17(6):511–4.
Boden SD, Dodge LD, Bohlman HH, Rechtine GR. 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.
Riew KD, Hilibrand AS, Palumbo MA, et al. Diagnosing basilar invagination in the rheumatoid patient. The reliability of radiographic criteria. J Bone Joint Surg Am. 2001;83(2):194–200.
Peppelman WC, Kraus DR, Donaldson 3rd WF, Agarwal A. Cervical spine surgery in rheumatoid arthritis: improvement of neurologic deficit after cervical spine fusion. Spine. 1993;18:2375–9.
Reiter MF, Boden SD. Inflammatory disorders of the cervical spine. Spine (Phila Pa 1976). 1998;23(24):2755–66.
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Han Jo Kim declares receipt of personal fees from Medtronic, Depuy, K2M, Biomet, and Stryker, outside the submitted work.
K Daniel Riew declares receipt of grants and/or research support from AOSpine, Cerapedics (FDA-IDE), and Medtronic (FDA-IDE); honoraria from NASS; and royalties from Biomet and Medtronic. He is a board member on the CSRS, Global Spine Journal, and AOSpine International.
Venu M Nemani and Richard Brasington declare no conflict of interest.
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Kim, H.J., Nemani, V.M., Riew, K.D. et al. Cervical Spine Disease in Rheumatoid Arthritis: Incidence, Manifestations, and Therapy. Curr Rheumatol Rep 17, 9 (2015). https://doi.org/10.1007/s11926-014-0486-8
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DOI: https://doi.org/10.1007/s11926-014-0486-8