The most common sites of rheumatoid arthritis (RA) are the metatarsophalangeal joints, followed by the metacarpophalangeal joints and the cervical spine (ankylosing spondylitis, rheumatoid spondylitis). Much of the understanding of spinal afflictions in rheumatoid arthritis was advanced by studies published in the 1950s and 1960s.[1] In 1951, Davis and Markley detailed medullary compression as a cause of death in patients with rheumatoid arthritis.[2] In 1969, Mathews reported that 25-30% of patients with rheumatoid arthritis who were admitted to the hospital had radiographic evidence of cervical spine involvement.[3]
Rheumatoid spondylitis (ankylosing spondylitis) primarily affects the cervical spine. Affliction of the thoracic or lumbar spine is rare. The anatomic abnormalities occur as a consequence of the destruction of synovial joints, ligaments, and bone. Abnormalities of the rheumatoid cervical spine generally can be grouped into 3 categories that may be seen in isolation or combined involvement, of which atlantoaxial instability (AAI) or atlantoaxial subluxation (AAS) is the most common abnormality (see the image below). AAS can be a fixed deformity or can be partially or fully reducible.
Rheumatoid spondylitis. Depiction of anterior subluxation of C1 on C2, retrodental pannus, and osseous erosions; the spinal cord is compressed between the pannus anteriorly and the posterior arch of the atlas. Superior migration of the odontoid (SMO) is the next most common abnormality and has alternately been referred to as cranial settling, pseudobasilar invagination, or vertical/upward translocation of the odontoid (see the following images).[4] The third and least common deformity is subaxial subluxation, which may be seen at multiple levels and produces a stepladder deformity.
Rheumatoid spondylitis. Depiction of superior migration of the odontoid into the foramen magnum with compression of the spinal cord. Rheumatoid spondylitis. Pertinent measurements of superior migration of the odontoid; cranial migration distance (CMD).
For patient education information, see eMedicine's Arthritis Center, as well as Rheumatoid Arthritis and Rheumatoid Arthritis Medications.
Go to Rheumatoid Arthritis and Ankylosing Spondylitis for more information on these topics.
Rheumatoid spondylitis (ankylosing spondylitis) primarily affects the cervical spine. Affliction of the thoracic or lumbar spine is rare. The anatomic abnormalities occur as a consequence of the destruction of synovial joints, ligaments, and bone. Abnormalities of the rheumatoid cervical spine generally can be grouped into 3 categories that may be seen in isolation or combined involvement, of which atlantoaxial instability (AAI) or atlantoaxial subluxation (AAS) is the most common abnormality (see the image below). AAS can be a fixed deformity or can be partially or fully reducible.
Rheumatoid spondylitis. Depiction of anterior subluxation of C1 on C2, retrodental pannus, and osseous erosions; the spinal cord is compressed between the pannus anteriorly and the posterior arch of the atlas. Superior migration of the odontoid (SMO) is the next most common abnormality and has alternately been referred to as cranial settling, pseudobasilar invagination, or vertical/upward translocation of the odontoid (see the following images).[4] The third and least common deformity is subaxial subluxation, which may be seen at multiple levels and produces a stepladder deformity.Rheumatoid spondylitis. Depiction of superior migration of the odontoid into the foramen magnum with compression of the spinal cord. Rheumatoid spondylitis. Pertinent measurements of superior migration of the odontoid; cranial migration distance (CMD).For patient education information, see eMedicine's Arthritis Center, as well as Rheumatoid Arthritis and Rheumatoid Arthritis Medications.
Go to Rheumatoid Arthritis and Ankylosing Spondylitis for more information on these topics.
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