Abstract
The radiological and clinical changes relating to cervical involvement in a group of 50 rheumatoid patients who had had the disease an average of 15.5 years were studied for an average follow-up period of 4.8 years.
In the initial study, thirty (60%) of 50 patients already had radiological changes of the rheumatoid cervical spine, consisting of atlanto-axial subluxation (AAS) in sixteen, AAS combined with vertical subluxation (VS) in ten, AAS with subaxial subluxation (SAS) in two, VS alone in one and C1/2 spontaneous fusion in one.
In the final review, thirty-seven (74%) had radiological changes of the cervical spine, consisting of AAS in nineteen, AAS with VS in eight, VS in three, SAS in three and VS with SAS in three. The remaining patient had combinations of all three types. AAS had progressed in sixteen patients (32%), VS in seven (14%) and SAS in seven (14%) . An improvement of AAS had occurred in seven patients, but six of them had accompanying VS or SAS. An improvement of VS occurred in one patient who had an absorption of the odontoid process. The development of VS and SAS was found in a patient with pre-existing AAS.
Although neck pain was the one symptom of the rheumatoid cervical disease that showed any tendency to improve, neural involvement was progressive.
Radiological progression of cervical involvement was correlated to high continuous activity of rheumatoid arthritis.
