Cervical Instabilities Progress in Rheumatoid Arthritis

Pre-existing vertical and subaxial subluxation changes hasten cervical instability progression

TUESDAY, April 26 (HealthDay News) -- In patients with rheumatoid arthritis (RA), vertical subluxation (VS) and subaxial subluxation (SAS) increase over time, especially in patients with pre-existing VS, SAS, and/or mutilating changes, according to a study published in the April 15 issue of Spine.

Takashi Yurube, M.D., from the Kobe University Graduate School of Medicine in Japan, and colleagues determined the natural course of cervical instability and predictors for prognosis of cervical spine in 267 patients with definite or classical RA. During a five-year follow-up, they assessed RA stages and mutilating changes in hand radiograms. Instabilities were classified as atlantoaxial subluxation (AAS), VS, and SAS. Aggravation of pre-existing instabilities and development of new instabilities were measured.

The investigators found that 52.4 percent of patients did not have cervical instability at the beginning of the study, and this decreased to 29.6 percent at the end, and the number of patients with VS and SAS increased significantly. Patients with pre-existing instabilities had higher rates of VS aggravation: 25.7 percent of patients with AAS, 49.1 percent with VS, and 41.2 percent with SAS. SAS was aggravated in 47.2 percent of patients with VS and 64.7 percent with SAS. Incidence of VS and SAS aggravation was significantly higher in patients with pre-existing mutilating changes. Cases that developed into mutilating changes during the follow-up were more likely to have aggravations of these instabilities.

"These pre-existing changes may be the important radiological aggravating predictors for RA cervical spine over a five-year period," the authors write.

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