Department of Internal Medicine, Japanese Red Cross Kitami Hospital, N6E2, Kitami, Hokkaido, 090-8666, Japan.
Department of Infectious Diseases, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
Clin Rheumatol. 2023 Jul;42(7):1875-1884. doi: 10.1007/s10067-023-06586-9. Epub 2023 Mar 31.
INTRODUCTION/OBJECTIVES: Cervical spine involvement is one of the most serious complications in rheumatoid arthritis (RA). The study aim was to assess the clinical significance of atlantoaxial (AA) joint involvement detected by F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) with computed tomography (CT) in patients with RA.
A prospective cross-sectional study was conducted to evaluate AA joint involvement detected by FDG-PET/CT in consecutive RA patients from December 2017 to February 2022. We investigated the relationship between AA joint involvement and clinical data, including disease activity and patients' cervical symptoms.
Among 48 patients enrolled, abnormal FDG uptake at AA joint was detected in 13 (27%). Rheumatoid factor titre, initial disease activity score 28-erythrocyte sedimentation rate and total standardized uptake value were significantly higher in the 13 patients than in the others (P = 0.004, P < 0.001 and P = 0.001, respectively). All patients with abnormal FDG uptake at AA joint had some cervical symptoms regardless of cervical spine X-ray abnormalities. Neck pain on movement and at rest were more frequent in the 13 patients than in the others (P = 0.001 and P = 0.004, respectively). The most sensitive symptom associated with AA joint involvement was neck pain on movement (sensitivity, 69%), and the most specific symptom was neck pain at rest (specificity, 100%).
AA joint involvement was commonly observed by FDG-PET/CT in patients with active RA, independent of radiographic findings. Specific cervical symptoms can be important surrogate markers for detection of potential AA synovitis associated with active RA. Key Points • AA joint involvement was frequently seen in RA with high disease activity independent of radiographic findings. • Neck pain was a hallmark of AA joint involvement reflecting disease activity, and resting pain was highly specific.
介绍/目的：颈椎受累是类风湿关节炎（RA）最严重的并发症之一。本研究旨在评估 F-氟脱氧葡萄糖（FDG）-正电子发射断层扫描（PET）与计算机断层扫描（CT）联合检测 RA 患者寰枢（AA）关节受累的临床意义。
对 2017 年 12 月至 2022 年 2 月连续收治的 RA 患者进行前瞻性横断面研究，评估 FDG-PET/CT 检测到的 AA 关节受累情况。我们调查了 AA 关节受累与临床数据（包括疾病活动度和患者的颈椎症状）之间的关系。
在纳入的 48 例患者中，13 例（27%）检测到 AA 关节异常 FDG 摄取。在有异常 FDG 摄取的 13 例患者中，类风湿因子滴度、初始疾病活动评分 28-红细胞沉降率和总标准化摄取值明显高于其他患者（P=0.004、P<0.001 和 P=0.001）。所有 AA 关节有异常 FDG 摄取的患者都有一些颈椎症状，无论颈椎 X 线片是否异常。在有异常 FDG 摄取的 13 例患者中，活动时和休息时的颈部疼痛比其他患者更常见（P=0.001 和 P=0.004）。与 AA 关节受累最相关的敏感症状是活动时的颈部疼痛（敏感性，69%），最特异的症状是休息时的颈部疼痛（特异性，100%）。
在活动期 RA 患者中，FDG-PET/CT 常能检测到 AA 关节受累，而与影像学结果无关。特定的颈椎症状可能是检测与活动期 RA 相关潜在 AA 滑膜炎的重要替代标志物。关键点：• 在活动期 RA 患者中，AA 关节受累常见，与影像学结果无关。• 颈部疼痛是 AA 关节受累的标志，反映疾病活动度，而休息时疼痛具有高度特异性。
