INTRODUCTION: The involvement of the cervical spine is a common feature of rheumatoid arthritis (RA). OBJECTIVE: To study the prevalence of radiographic changes of the cervical spine in patients with RA and their association with clinical and serological profiles of the disease. METHODS: We analysed lateral (neutral position, hyperextension, hyperflexion) and transoral views of cervical spine radiographs from 80 individuals with RA to investigate the presence of atlanto-axial subluxation (AAS), basilar invagination (BI), and subaxial instability (SAI). Demographic, clinical (nodules, interstitial pneumonitis, secondary Sjögren's syndrome, medications etc.), and serologic (rheumatoid factor - RF, cyclic citrullinated peptide antibody - anti-CCP, and antinuclear factor - ANF) data were obtained from the clinical records. RESULTS: Cervical spine misalignments were identified in 26/80 (32.5%) participants; AAS occurred in 12/80 (15%) participants, BI in 6/80 (7.5%), and SAI in 13/80 (32.5%). Odontoid erosions were identified in 16/80 (20.0%) participants. Cervical spine misalignment exhibited associations with age at onset and disease duration (P = 0.03 and 0.02, respectively). No associations were identified between the cervical spine changes and the participants' ethnicity or gender, presence of nodules, interstitial pneumonitis, secondary Sjögren's syndrome, RF, ANF, or anti-CCP. The participants with cervical spine misalignment exhibited higher frequencies of odontoid erosion (P = 0.03). CONCLUSIONS: Cervical spine misalignment was a common radiographic finding and occurred more frequently in participants with earlier onset and longer length of RA.
Rheumatoid arthritis; Cervical spine; Atlanto-axial luxation; Basilar invagination; Subaxial instability
