RESEARCH - Cervical spine involvement in RA: correlation between neurological manifestations and MRI findings

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Rheumatology Advance Access published online on October 16, 2008

Rheumatology, doi:10.1093/rheumatology/ken314

Cervical spine involvement in rheumatoid arthritis: correlation

between neurological manifestations and magnetic resonance imaging

findings

J. A. Narváez1,*, J. Narváez2,*, M. Serrallonga3, E. De Lama1, M. de

Albert1, R. Mast1 and J. M. Nolla2

1Department of Radiology 2Department of Rheumatology,

Bellvitge-IDIBELL, University Hospital and 3Institute of Diagnostic

Imaging (IDI), Bellvitge Centre, Barcelona, Spain.

Abstract

Objective. To evaluate the correlation between neurological deficits

indicative of compressive myelopathy and MRI findings in a series of

patients with RA and symptomatic involvement of the cervical spine.

Methods. Forty-one consecutive patients with RA were studied using

cervical spine MRI. Unconditional logistic regression analysis was

used to identify MRI parameters of cervical spine involvement

associated with the development of neurological dysfunction.

Results. The mean age of the 41 patients (33 women and 8 men) was 59

yrs (range 23–82 yrs), while the median disease duration was 18 ± 9

yrs (range 4–40 yrs). According to Ranawat's classification, 17 (42%)

patients were in Class I, 21 (51%) in Class II and 3 (7%) in Class

III. Thus, patients with clinical manifestations of compressive

myelopathy (Ranawat's Class II + III) represented 58% (24/41) of all

cases.

Among the different MRI parameters of cervical spine involvement

analysed, only the presence of atlantoaxial spinal canal stenosis

[odds ratio (OR) 4.55; 95% CI 1.14–18.15], atlantoaxial cervical cord

compression (OR 9.6; 95% CI 1.08–85.16) and subaxial myelopathy

changes (OR 11.43; 95% CI 1.3–100.81) were associated with a

significantly increased risk for neurological dysfunction (Ranawat's

Class II or III).

Conclusion. In RA patients with symptomatic cervical spine

involvement, there is a strong correlation between the development of

neurological dysfunction and MRI identification of atlantoaxial spinal

canal stenosis, especially in those cases with evidence of upper

cervical cord or brainstem compression and subaxial myelopathy

changes.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken314v1?papetoc

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