OBJECTIVE: The long-term pattern of cervical involvement in patients with a diagnosis of rheumatoid arthritis was investigated, correlating the imaging findings with neurological symptoms, medication used, duration of the disease, age of onset, laboratory tests and clinical picture. METHODS: This same group of patients had already been studied for some time, and data were compared to verify if there was a worsening of the involvement pattern throughout time. Plain X-rays were obtained from the cervical column, in anteroposterior and neutral and dynamic lateral views. The Ranawat classification was used to evaluate pain symptoms and neurological involvement. For the analysis, the authors used the univariate logistic regression tests (p<0.05). RESULTS: Twenty-four of the 35 patients from the previous sample were evaluated and seven were lost to follow up. The authors found some statistically significant correlations: bicipital reflex (p=0.049) and the Ranawat method (p=0.023 with extension X-ray and p=0.034 with a neutral X-ray) with a stable column, erosion of the dens axis (p=0.048) and lateral subluxation (p=0.22) with atlanto-axial instability and the Lhermitte signal (p=0.025) with basilar invagination. Cervical instability was found in 66.6% (16/24) of the patients, and there was a significant statistical increase of the subaxial instability for the past 6 years (p=0.032). CONCLUSIONS: In a decreasing order of occurrence, the authors were able to verify the following types of instability: atlanto-axial subluxation, 50%; subaxial subluxation, 41.6%; and basilar invagination, 16.6%. An increase in the number of patients with subaxial instability was verified, and no correlation was observed regarding the age of onset. Additionally, no correlation was found between the bicipital reflex and any type of instability but rather with a stable column, and this result is different from what the authors obtained in the previous series.
Rheumatoid Arthritis; Bone Diseases; X-ray; Blood tests; Signs and Symptoms
