RESEARCH - Bone marrow edema in the cervical spine of symptomatic RA patients

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Semin Arthritis Rheum. 2008 Mar 11

Bone Marrow Edema in the Cervical Spine of Symptomatic Rheumatoid

Arthritis Patients.

Narváez JA, Narváez J, Albert MD, De Lama E, Serrallonga M, Nolla JM.

Department of Radiology, Hospital Universitario de Bellvitge-IDIBELL,

Barcelona, Spain.

OBJECTIVE: To investigate the frequency and clinical significance of

bone marrow edema (BME) in a series of patients with rheumatoid

arthritis (RA) and symptomatic involvement of the cervical spine.

METHODS: We studied 19 consecutive RA patients with cervical spine

magnetic resonance imaging (MRI) according to a specifically designed

protocol that included short inversion time inversion recovery

sequences. All cases had neck pain unresponsive to conventional

treatment, neurological symptoms, or signs suggestive of cervical

myelopathy, or cervical pain with evidence of atlantoaxial subluxation

on radiographs. RESULTS: The mean age of the 19 patients (15 women and

4 men) at time of the study was 59 +/- 12 years (range, 23-82) and the

median disease duration was 14 +/- 7.4 years (range, 4-30). BME was

observed in 74% (14/19) of the patients: at the atlantoaxial level

alone in 16% of the patients; subaxially alone in 16%; and at both

levels in 42% of the patients. At the atlantoaxial level, BME was

usually observed involving the odontoid process, whereas subaxially

BME was limited to the vertebral plates and the interapophyseal

joints. Patients with BME had higher erythrocyte sedimentation rate

(ESR) values at the time of MRI examination (P = 0.014) and more

severe atlantoaxial joint MRI synovitis scores (P = 0.05) compared

with the remaining patients; the frequency of odontoid erosions was

also greater in this group, but the difference did not reach

statistical significance. Altogether, these data suggest a more severe

inflammatory response in these patients. In this group a significant

correlation was found between BME scores at atlantoaxial level and (1)

ESR values (r = 0.854; P = 0.001) and (2) atlantoaxial joint MRI

synovitis scores (r = 0.691; P = 0.001).

CONCLUSION: BME is frequently observed in patients with established RA

and symptomatic cervical spine involvement. Both atlantoaxial and

subaxial levels are equally affected. Presence of BME seems related to

the intensity of the inflammatory response and to the severity of the

atlantoaxial joint synovitis.

PMID: 18336873

http://www.ncbi.nlm.nih.gov/pubmed/18336873

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