Neva M H, Kotaniemi A, Kaarela K, Lehtinen J T, Belt E A, Kauppi M
Division of Orthopaedic and Trauma Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland.
Clin Exp Rheumatol. 2003 Mar-Apr;21(2):179-84.
To evaluate whether cervical spine changes are associated with the destruction of shoulder or peripheral joints and with bone mineral density (BMD) in patients with long-term RA.
An inception cohort of 67 patients with seropositive and erosive RA were followed up for 20 years. Cervical spine, shoulder, hand and foot radiographs, and the BMD of the lumbar spine and femoral neck were evaluated.
A positive relationship was detected between the occurrence of atlantoaxial disorders and the destruction of both shoulder (p < 0.001) and peripheral (p = 0.001) joints. In addition, the severity of anterior atlantoaxial subluxation and atlantoaxial impaction positively correlated with the grade of destruction in the evaluated joints. Furthermore, patients with atlantoaxial disorders presented decreased BMD of the femoral neck (p = 0.019). The occurrences of subaxial subluxations (SAS) and subaxial disc space narrowings only associated with higher onset age of RA.
Patients with severe RA and osteoporosis have an increased risk for atlantoaxial disorders. The co-existence of shoulder destruction and cervical spine disorders makes the differential diagnosis of shoulder and neck pain challenging.
评估长期类风湿关节炎（RA）患者颈椎改变是否与肩部或外周关节破坏以及骨密度（BMD）相关。
对67例血清学阳性且有侵蚀性RA的初发队列患者进行了20年的随访。评估了颈椎、肩部、手部和足部的X线片，以及腰椎和股骨颈的骨密度。
寰枢椎疾病的发生与肩部（p < 0.001）和外周（p = 0.001）关节的破坏之间存在正相关关系。此外，寰枢椎前脱位和寰枢椎撞击的严重程度与所评估关节的破坏程度呈正相关。此外，患有寰枢椎疾病的患者股骨颈骨密度降低（p = 0.019）。下颈椎半脱位（SAS）和下颈椎椎间盘间隙变窄的发生仅与RA的发病年龄较高有关。
重度RA和骨质疏松症患者发生寰枢椎疾病的风险增加。肩部破坏和颈椎疾病并存使得肩部和颈部疼痛的鉴别诊断具有挑战性。
