Atlanto-Axial Subluxation in Iraqi Patients With Rheumatoid Arthritis

Abstract

Background: Rheumatoid arthritis (RA) is a chronic multisystemic disease which can lead to significant deformities and functional disability.

Objectives: To assess   atlanto-axial subluxation (AAS) in Iraqi patients with RA; and to evaluate its correlations with patients characteristics if present.

Patients and methods: A cross sectional study was conducted on 109 patients with RA diagnosed according to the American College of Rheumatology Criteria for the classification of RA.  Patients’ baseline characteristics included: age, sex, duration of RA illness, functional status, hand deformities, symptoms and signs suggestive of cervical myelopathy, and drugs related history, Disease Activity Score for 28 joints (DAS 28), erythrocyte sedimentation rate (ESR), and Rheumatoid Factor (RF).  X-ray of cervical spines lateral view, involving both flexion and extension was done.  AAS was diagnosed when the separation between atlas and axis >3 mm during flexion part.

Results There were 109 RA patients included in this study, the mean age of them was (45.85± 10.35) years. Ninety seven patients (89%) were females. AAS was present in 30 (27.52%) patients and it was significantly associated with longer disease duration (p=0.01), RF positivity (p=0.014), lower functional class (p=0.03), hand deformities (p<0.01), and advancing disease progression stage (p=0.01). No significant relationship between AAS with: patients’ age, gender, DAS 28, VAS of the patient, and smoking.

Conclusions: AAS was common in patients with RA.  In patients with RA, AAS was significantly associated with: longer disease duration, RF positivity, lower functional class, hand deformities, and advancing disease progression.

Keywords: Rheumatoid arthritis, atlanto-axial subluxation, cervical spine, baseline characteristics