Mnif Ichrak, Feki Afef, Sellami Imen, Kammoun Amina, Gassara Zouhour, Baklouti Sofien, Mnif Zeinab, Fourati Hela, Feki Wiem
Departement of Rheumatology, Hedi Chaker Hospital, Sfax, Tunisia.
Departement of Occupational Health, Hedi Chaker Hospital, Sfax, Tunisia.
Musculoskeletal Care. 2025 Jun;23(2):e70145. doi: 10.1002/msc.70145.
Cervical spine involvement remains one of the more serious complications of rheumatoid arthritis (RA). Several factors interfere with the occurrence of this complication. The aim of this work was to identify the risk factors associated with cervical involvement, specifying the contribution of MRI in screening for rheumatoid cervical spine and discussing the value of standard X-rays.
A cross-sectional study included 100 patients with RA who underwent both standard radiography and MRI of the cervical spine. Clinical, paraclinical and therapeutic data were collected.
Cervical pain was the predominant functional sign. It was mechanical in 44% of cases and inflammatory in 29%. Physical signs revealed on clinical examination included: pain on cervical spine mobilisation (49%), cervical stiffness (37%) and abnormal neurological examination in 3% of cases. Standard radiographs revealed C1-C2 instability in 52% of cases: vertical displacement (28%), rotatory displacement (22%), anterior displacement (19%) and lateral displacement (1%). MRI confirmed the presence of the following types of atlantoaxial subluxation: vertical (34%) and anterior subluxation (27%). Other lesions were identified on MRI: synovial thickening (31%) with contrast enhancement (17%), hyperintensity on diffusion-weighted imaging (DWI; 6%) and odontoid erosion (16%). Cervico-Medullar Angle (CMA) was pathological (CMA < 135°) in 3% of patients. A study of the correlation between patient-related parameters, RA-related parameters, cervical symptomatology-related parameters and rheumatoid C1-C2 involvement concluded that age was positively correlated with C1-C2 instability (p = 0.036), as was the presence of Rheumatoid Factor (RF) (p = 0.038), coxitis (p = 0.042) and dry eye syndrome (p = 0.039). Cervical spine stiffness was positively correlated with C1-C2 instability (p = 0.01). The presence of inflammatory cervical pain (p = 0), and painful mobilisation on examination (p = 0.03) were correlated with C1-C2 synovitis.
The 'RA and cervical spine' entity is associated with phenotypes of seropositive, destructive RA, with peripheral synovitis and systemic manifestations. Systematic clinical and radiological screening for this condition is essential to preserve functional prognosis. Diffusion imaging of the craniocervical region appears to be a valuable adjunct for the quantitative assessment of synovitis.
颈椎受累仍是类风湿关节炎（RA）较为严重的并发症之一。多种因素会影响该并发症的发生。本研究旨在确定与颈椎受累相关的危险因素，明确MRI在类风湿性颈椎筛查中的作用，并探讨标准X线的价值。
一项横断面研究纳入了100例接受颈椎标准X线和MRI检查的RA患者。收集了临床、辅助检查及治疗数据。
颈部疼痛是主要的功能体征。44%的病例为机械性疼痛，29%为炎症性疼痛。临床检查发现的体征包括：颈椎活动时疼痛（49%）、颈部僵硬（37%），3%的病例神经系统检查异常。标准X线显示52%的病例存在C1-C2不稳定：垂直移位（28%）、旋转移位（22%）、前移位（19%）和侧方移位（1%）。MRI证实存在以下类型的寰枢椎半脱位：垂直半脱位（34%）和前半脱位（27%）。MRI还发现了其他病变：滑膜增厚（31%）伴强化（17%）、弥散加权成像（DWI）高信号（6%）和齿状突侵蚀（16%）。3%的患者颈髓角（CMA）异常（CMA < 135°）。一项关于患者相关参数、RA相关参数、颈椎症状相关参数与类风湿性C1-C2受累之间相关性的研究得出结论，年龄与C1-C2不稳定呈正相关（p = 0.036），类风湿因子（RF）阳性（p = 0.038）、髋关节炎（p = 0.042）和干眼症（p = 0.039）也与之呈正相关。颈椎僵硬与C1-C2不稳定呈正相关（p = 0.01）。炎症性颈部疼痛（p = 0）和检查时活动疼痛（p = 0.03）与C1-C2滑膜炎相关。
“RA与颈椎”这一情况与血清学阳性、破坏性RA的表型相关，伴有外周滑膜炎和全身表现。对此病症进行系统的临床和放射学筛查对于保留功能预后至关重要。颅颈区域的弥散成像似乎是滑膜炎定量评估的有价值辅助手段。
