Drosos Alexandros A, Pelechas Eleftherios, Georgiadis Athanasios N, Voulgari Paraskevi V
Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
Mediterr J Rheumatol. 2021 Aug 25;32(3):256-263. doi: 10.31138/mjr.32.3.256. eCollection 2021 Sep.
Rheumatoid arthritis (RA) may affect any diarthrodial joint with a predilection on the peripheral skeleton in a symmetrical manner. When the axial skeleton is affected, it is the cervical spine (CS) that gets involved with potentially detrimental effects, if not treated promptly.
A 60-year-old female suffering from RA presented with severe neck pain and stiffness, difficulty of standing and walking with brisk tendon reflexes, Babinski sign positive, and clonus. Despite the high inflammatory markers and high titres of autoantibodies (rheumatoid factor and anticitrullinated protein antibodies), she never received proper treatment. She was using only paracetamol and non-steroidal anti-inflammatory drugs. Conventional radiography (CR) of CS showed extensive degenerative changes affecting the C3-C5 vertebral level. Magnetic Resonance Imaging of the neck showed sub-axial subluxation (SAS) and spinal cord compression at C3 level, and to a lesser extent, in other levels. A multi-level cervical laminectomy and spinal cord decompression were deployed with good results. To this end, literature review was performed until September 2020 and showed that the frequency of radiological findings varies substantially, ranging between 0,7-95% in different studies. The most common radiological feature is the atlanto-axial subluxation (AAS) followed by SAS. Because CS involvement can often be clinically asymptomatic, its assessment should not be forgotten by physicians and should be assessed using CR, which is an easy-to-perform technique and gives important information as a screening tool. On the other hand, RA patients need to be treated in a prompt and efficient manner in order to avoid any potentially fatal complications.
类风湿关节炎（RA）可累及任何滑膜关节，以对称方式好发于外周骨骼。当累及中轴骨骼时，若不及时治疗，颈椎（CS）会受到影响并产生潜在的有害影响。
一名60岁患类风湿关节炎的女性，出现严重颈部疼痛和僵硬，站立和行走困难，腱反射亢进，巴宾斯基征阳性及阵挛。尽管炎症指标高且自身抗体（类风湿因子和抗瓜氨酸化蛋白抗体）滴度高，但她从未接受过正规治疗。她仅使用对乙酰氨基酚和非甾体类抗炎药。颈椎的传统X线摄影（CR）显示C3 - C5椎体水平有广泛的退行性改变。颈部磁共振成像显示C3水平以下有下颈椎半脱位（SAS）和脊髓受压，其他水平受压程度较轻。实施了多节段颈椎椎板切除术和脊髓减压术，效果良好。为此，检索了截至2020年9月的文献，结果显示不同研究中影像学表现的发生率差异很大，在0.7% - 95%之间。最常见的影像学特征是寰枢椎半脱位（AAS），其次是SAS。由于颈椎受累在临床上常无症状，医生不应忽视对其评估，应使用CR进行评估，CR是一种易于操作的技术，作为筛查工具可提供重要信息。另一方面，RA患者需要及时、有效地治疗，以避免任何潜在的致命并发症。
