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Musculoskeletal
Diagnosis
Non-Trauma
Arthritis
Erosive
Rheumatoid Arthritis of Axial Skeleton
Rheumatoid Arthritis of Axial Skeleton
Eva M. Escobedo, MD; Stephanie A. Bernard, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Rheumatoid arthritis (RA)

          • Definitions

            • Chronic progressive systemic inflammatory disease in which joints are primary target
              • Atlantoaxial subluxation (AAS) = C1-C2 subluxation
              • Atlantoaxial impaction (AAI) = cranial settling = basilar impression = vertical subluxation (VS) = migration of odontoid
              • Subaxial subluxation (SAS): involvement of cervical spine below C1-C2 level

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Baek IW et al: Risk factors for cervical spine instability in patients with rheumatoid arthritis. Clin Rheumatol. 40(2):547-55, 2021
                                      2. Guyard T et al: Reproducibility and diagnostic value of a new method using ratios to diagnose anterior atlanto-axial subluxation on plain radiographs. Joint Bone Spine. 88(5):105229, 2021
                                      3. Uchino Y et al: Risk factors associated with cervical spine lesions in patients with rheumatoid arthritis: an observational study. BMC Musculoskelet Disord. 22(1):408, 2021
                                      4. Joo P et al: Surgical management of the lumbar spine in rheumatoid arthritis. Global Spine J. 10(6):767-74, 2020
                                      5. Shlobin NA et al: Cervical spine manifestations of rheumatoid arthritis: a review. Neurosurg Rev. 44(4):1957-65, 2020
                                      6. Suzuki A et al: Do rheumatoid arthritis patients have low back pain or radiological lumbar lesions more frequently than the healthy population? - Cross-sectional analysis in a cohort study with age and sex-matched healthy volunteers. Spine J. 20(12):1995-2002, 2020
                                      7. Reijnierse M et al: Magnetic resonance imaging of rheumatoid arthritis: peripheral joints and spine. Semin Musculoskelet Radiol. 22(2):127-46, 2018
                                      8. Mańczak M et al: Cervical spine instability in the course of rheumatoid arthritis - imaging methods. Reumatologia. 55(4):201-7, 2017
                                      9. Gillick JL et al: Rheumatoid arthritis and the cervical spine: a review on the role of surgery. Int J Rheumatol. 2015:252456, 2015
                                      10. Joaquim AF et al: Radiological evaluation of cervical spine involvement in rheumatoid arthritis. Neurosurg Focus. 38(4):E4, 2015
                                      11. Wallis D et al: Tumour necrosis factor inhibitor therapy and infection risk in axial spondyloarthritis: results from a longitudinal observational cohort. Rheumatology (Oxford). 54(1):152-6, 2015
                                      12. Del Grande M et al: Cervical spine involvement early in the course of rheumatoid arthritis. Semin Arthritis Rheum. 43(6):738-44, 2014
                                      13. Iizuka H et al: Effect of a reduction of the atlanto-axial angle on the cranio-cervical and subaxial angles following atlanto-axial arthrodesis in rheumatoid arthritis. Eur Spine J. 22(5):1137-41, 2013
                                      14. Kaito T et al: Predictors for the progression of cervical lesion in rheumatoid arthritis under the treatment of biological agents. Spine (Phila Pa 1976). 38(26):2258-63, 2013
                                      15. Kauppi MJ et al: Rheumatoid atlantoaxial subluxation can be prevented by intensive use of traditional disease modifying antirheumatic drugs. J Rheumatol. 36(2):273-8, 2009
                                      16. Narváez JA et al: Bone marrow edema in the cervical spine of symptomatic rheumatoid arthritis patients. Semin Arthritis Rheum. 38(4):281-8, 2009
                                      17. Restrepo CS et al: Imaging appearances of the sternum and sternoclavicular joints. Radiographics. 29(3):839-59, 2009
                                      18. Goel A et al: Immediate postoperative regression of retroodontoid pannus after lateral mass reconstruction in a patient with rheumatoid disease of the craniovertebral junction. Case report. J Neurosurg Spine. 9(3):273-6, 2008
                                      19. Iizuka H et al: Relationship between the morphology of the atlanto-occipital joint and the radiographic results in patients with atlanto-axial subluxation due to rheumatoid arthritis. Eur Spine J. 17(6):826-30, 2008
                                      20. Kelleher MO et al: Lateral mass screw fixation of complex spine cases: a prospective clinical study. Br J Neurosurg. 22(5):663-8, 2008
                                      21. Narváez JA et al: Cervical spine involvement in rheumatoid arthritis: correlation between neurological manifestations and magnetic resonance imaging findings. Rheumatology (Oxford). 47(12):1814-9, 2008
                                      22. Neo M: Treatment of upper cervical spine involvement in rheumatoid arthritis patients. Mod Rheumatol. 18(4):327-35, 2008
                                      23. Paus AC et al: High mortality rate in rheumatoid arthritis with subluxation of the cervical spine: a cohort study of operated and nonoperated patients. Spine. 33(21):2278-83, 2008
                                      24. Takatori R et al: In vivo segmental motion of the cervical spine in rheumatoid arthritis patients with atlantoaxial subluxation. Clin Exp Rheumatol. 26(3):442-8, 2008
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Clinical Issues

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Rheumatoid arthritis (RA)

                                              • Definitions

                                                • Chronic progressive systemic inflammatory disease in which joints are primary target
                                                  • Atlantoaxial subluxation (AAS) = C1-C2 subluxation
                                                  • Atlantoaxial impaction (AAI) = cranial settling = basilar impression = vertical subluxation (VS) = migration of odontoid
                                                  • Subaxial subluxation (SAS): involvement of cervical spine below C1-C2 level

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • MR Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Gross Pathologic & Surgical Features

                                                              • Microscopic Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Baek IW et al: Risk factors for cervical spine instability in patients with rheumatoid arthritis. Clin Rheumatol. 40(2):547-55, 2021
                                                                          2. Guyard T et al: Reproducibility and diagnostic value of a new method using ratios to diagnose anterior atlanto-axial subluxation on plain radiographs. Joint Bone Spine. 88(5):105229, 2021
                                                                          3. Uchino Y et al: Risk factors associated with cervical spine lesions in patients with rheumatoid arthritis: an observational study. BMC Musculoskelet Disord. 22(1):408, 2021
                                                                          4. Joo P et al: Surgical management of the lumbar spine in rheumatoid arthritis. Global Spine J. 10(6):767-74, 2020
                                                                          5. Shlobin NA et al: Cervical spine manifestations of rheumatoid arthritis: a review. Neurosurg Rev. 44(4):1957-65, 2020
                                                                          6. Suzuki A et al: Do rheumatoid arthritis patients have low back pain or radiological lumbar lesions more frequently than the healthy population? - Cross-sectional analysis in a cohort study with age and sex-matched healthy volunteers. Spine J. 20(12):1995-2002, 2020
                                                                          7. Reijnierse M et al: Magnetic resonance imaging of rheumatoid arthritis: peripheral joints and spine. Semin Musculoskelet Radiol. 22(2):127-46, 2018
                                                                          8. Mańczak M et al: Cervical spine instability in the course of rheumatoid arthritis - imaging methods. Reumatologia. 55(4):201-7, 2017
                                                                          9. Gillick JL et al: Rheumatoid arthritis and the cervical spine: a review on the role of surgery. Int J Rheumatol. 2015:252456, 2015
                                                                          10. Joaquim AF et al: Radiological evaluation of cervical spine involvement in rheumatoid arthritis. Neurosurg Focus. 38(4):E4, 2015
                                                                          11. Wallis D et al: Tumour necrosis factor inhibitor therapy and infection risk in axial spondyloarthritis: results from a longitudinal observational cohort. Rheumatology (Oxford). 54(1):152-6, 2015
                                                                          12. Del Grande M et al: Cervical spine involvement early in the course of rheumatoid arthritis. Semin Arthritis Rheum. 43(6):738-44, 2014
                                                                          13. Iizuka H et al: Effect of a reduction of the atlanto-axial angle on the cranio-cervical and subaxial angles following atlanto-axial arthrodesis in rheumatoid arthritis. Eur Spine J. 22(5):1137-41, 2013
                                                                          14. Kaito T et al: Predictors for the progression of cervical lesion in rheumatoid arthritis under the treatment of biological agents. Spine (Phila Pa 1976). 38(26):2258-63, 2013
                                                                          15. Kauppi MJ et al: Rheumatoid atlantoaxial subluxation can be prevented by intensive use of traditional disease modifying antirheumatic drugs. J Rheumatol. 36(2):273-8, 2009
                                                                          16. Narváez JA et al: Bone marrow edema in the cervical spine of symptomatic rheumatoid arthritis patients. Semin Arthritis Rheum. 38(4):281-8, 2009
                                                                          17. Restrepo CS et al: Imaging appearances of the sternum and sternoclavicular joints. Radiographics. 29(3):839-59, 2009
                                                                          18. Goel A et al: Immediate postoperative regression of retroodontoid pannus after lateral mass reconstruction in a patient with rheumatoid disease of the craniovertebral junction. Case report. J Neurosurg Spine. 9(3):273-6, 2008
                                                                          19. Iizuka H et al: Relationship between the morphology of the atlanto-occipital joint and the radiographic results in patients with atlanto-axial subluxation due to rheumatoid arthritis. Eur Spine J. 17(6):826-30, 2008
                                                                          20. Kelleher MO et al: Lateral mass screw fixation of complex spine cases: a prospective clinical study. Br J Neurosurg. 22(5):663-8, 2008
                                                                          21. Narváez JA et al: Cervical spine involvement in rheumatoid arthritis: correlation between neurological manifestations and magnetic resonance imaging findings. Rheumatology (Oxford). 47(12):1814-9, 2008
                                                                          22. Neo M: Treatment of upper cervical spine involvement in rheumatoid arthritis patients. Mod Rheumatol. 18(4):327-35, 2008
                                                                          23. Paus AC et al: High mortality rate in rheumatoid arthritis with subluxation of the cervical spine: a cohort study of operated and nonoperated patients. Spine. 33(21):2278-83, 2008
                                                                          24. Takatori R et al: In vivo segmental motion of the cervical spine in rheumatoid arthritis patients with atlantoaxial subluxation. Clin Exp Rheumatol. 26(3):442-8, 2008