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Radiological Cervical Spine Involvement in Patients with Rheumatoid Arthritis: A Cross Sectional Study
ANASTASIA K. ZIKOU, YANNIS ALAMANOS, MARIA I. ARGYROPOULOU, NIKI TSIFETAKI, CONSTANTINOS TSAMPOULAS, PARASKEVI V. VOULGARI, STAVROS C. EFREMIDIS, and ALEXANDROS A. DROSOS
ABSTRACT.
Methods. We investigated 165 consecutive unselected patients with RA who fulfilled the revised American College of Rheumatology criteria for RA. All patients had a complete physical and laboratory evaluation. Patients had a radiological evaluation that included hand and wrist radiographs, as well as cervical spine radiographs in anteroposterior, lateral, and lateral in full flexion views. Hand radiographs were evaluated according to the Larsen criteria, while cervical radiographs were evaluated according to Winfield classification. Results. There were 143 women and 22 men, with a mean age of 59.6 ± 12.5 and disease duration 12.3 ± 13.9 years. Positive rheumatoid factor was found in 63.6% of patients. One hundred forty-six patients presented radiological findings related to cervical spine involvement: atlantoaxial subluxations were found in 20.6% and erosions of the odontoid process in 2.4%; none presented vertical subluxation. Subaxial subluxations were found in 43.6%, disc space narrowing at C2–C3, C3–C4, C4–C5 levels in 66.1%, and vertebral plate sclerosis and erosions in 43.6%. Conclusion. Cervical spine radiological involvement is a frequent finding in our patients with RA, but the severity of the disease is rather mild, possibly related to the ethnic background. (J Rheumatol 2005;32:801-6) Key Indexing Terms:
CERVICAL SPINE
From the Department of Radiology, Department of Hygiene and Epidemiology; and Division of Rheumatology, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece. A.K. Zikou, MD, Registrar in Radiology; M.I. Argyropoulou, MD, Associate Professor of Radiology; C. Tsampoulas, MD, Associate Professor of Radiology; S.C. Efremidis, MD, Professor of Radiology, Department of Radiology; Y. Alamanos, MD, Assistant Professor of Hygiene and Epidemiology, Department of Hygiene and Epidemiology; N. Tsifetaki, MD, Registrar in Rheumatology; P.V. Voulgari, MD, Lecturer in Rheumatology; A.A. Drosos, MD, FACR, Professor of Medicine/Rheumatology, Division of Rheumatology. Address reprint requests to Dr. A.A. Drosos, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece. E-mail: adrosos@cc.uoi.gr Accepted for publication December 24, 2004. |