Al-Daoseri Husham A, Mohammed Saeed Mubder A, Ahmed Rafal A
Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Basrah University, Basrah, Iraq.
Department of Surgery, Faculty of Medicine, Basrah University, Basrah, Iraq.
J Clin Orthop Trauma. 2020 Sep-Oct;11(5):876-882. doi: 10.1016/j.jcot.2019.06.013. Epub 2019 Jun 14.
This study analysed the prevalence of cervical spine instability in Rheumatoid Arthritis (RA) patients following at a single centre in Basrah.
Data were collected directly from patients through cervical spine examinations. Each patient was sent for dynamic (flexion and extension) lateral cervical radiographic imaging to assess the presence of atlantoaxial subluxation (AAS), superior migration of the odontoid (SMO) and sub-axial subluxation (SAS). Patients with positive radiographic findings were sent for MRI scans of the cervical spine to assess neurological compression.
The prevalence rate of cervical spine instability in RA was 15/203 (7.4%) of the total sample, occurring primarily in patients of 37-65 years old (mean: 48 ± 8.9 years), were 3/15 (20%) aymptomatic. The majority (60%) being at the moderate stage of the disease activity (using a Clinical Disease Activity Index [CDAI). In terms of type of cervical spine involvement, isolated AAS was found to have the highest occurrence (73.3%), followed by combined SAS and SMO (13.3%), combined AAS and SMO (6.7%), and combined AAS and SAS (6.7%). A significant relationship was found between the type of cervical spine involvement in RA and a disease onset duration, disease activity, body mass index and peripheral erosion with P value < 0.05.
Cervical spine subluxation in RA patients may be asymptomatic It is therefore essential to obtain a dynamic radiographic image of the cervical spine in order to diagnose cervical spine involvement and protect the patient from severe outcomes.The clinical trial included in a the official document from Ministry of Higher Education and Science Research/Basrah University/Faculty of Medicine to Basrah Health Directorate/Research and Development Division is 72/3588 in 7 Jan 2017.
本研究分析了巴士拉某单一中心类风湿关节炎（RA）患者颈椎不稳定的患病率。
通过颈椎检查直接从患者处收集数据。每位患者均接受动态（屈伸）颈椎侧位X线成像，以评估寰枢椎半脱位（AAS）、齿状突上移（SMO）和下颈椎半脱位（SAS）的情况。X线检查结果阳性的患者接受颈椎MRI扫描以评估神经受压情况。
RA患者颈椎不稳定的患病率为总样本的15/203（7.4%），主要发生在37至65岁的患者中（平均：48±8.9岁），其中3/15（20%）无症状。大多数（60%）处于疾病活动的中度阶段（使用临床疾病活动指数[CDAI]）。就颈椎受累类型而言，孤立性AAS的发生率最高（73.3%），其次是SAS和SMO合并（13.3%）、AAS和SMO合并（6.7%）以及AAS和SAS合并（6.7%）。RA患者颈椎受累类型与疾病发病持续时间、疾病活动度、体重指数和外周侵蚀之间存在显著相关性，P值<0.05。
RA患者的颈椎半脱位可能无症状。因此，获取颈椎的动态X线影像对于诊断颈椎受累并防止患者出现严重后果至关重要。高等教育与科学研究部/巴士拉大学/医学院提交给巴士拉卫生局/研发部的官方文件中包含的2017年1月7日的临床试验编号为72/3588。
