A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review

Background: 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. Case: A...

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Autores principales:	Alexandros A. Drosos, Eleftherios Pelechas, Athanasios N. Georgiadis, Paraskevi V. Voulgari
Formato:	article
Lenguaje:	EN
Publicado:	PCO Convin S.A. 2021
Materias:	rheumatoid arthritis cervical spine conventional radiography neck pain joint instability atlanto-axial subluxation subaxial subluxation imaging Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/4cc00107d2334ff0a2f604efa3fab9de
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spelling	oai:doaj.org-article:4cc00107d2334ff0a2f604efa3fab9de2021-11-08T08:28:47ZA not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review2529-198X10.31138/mjr.32.3.256https://doaj.org/article/4cc00107d2334ff0a2f604efa3fab9de2021-01-01T00:00:00Zhttp://www.mjrheum.org/assets/files/792/file323_1362.pdfhttps://doaj.org/toc/2529-198XBackground: 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. Case: 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.Alexandros A. DrososEleftherios PelechasAthanasios N. GeorgiadisParaskevi V. VoulgariPCO Convin S.A.articlerheumatoid arthritiscervical spineconventional radiographyneck painjoint instabilityatlanto-axial subluxationsubaxial subluxationimagingDiseases of the musculoskeletal systemRC925-935ENMediterranean Journal of Rheumatology, Vol 32, Iss 3, Pp 256-263 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	rheumatoid arthritis cervical spine conventional radiography neck pain joint instability atlanto-axial subluxation subaxial subluxation imaging Diseases of the musculoskeletal system RC925-935
spellingShingle	rheumatoid arthritis cervical spine conventional radiography neck pain joint instability atlanto-axial subluxation subaxial subluxation imaging Diseases of the musculoskeletal system RC925-935 Alexandros A. Drosos Eleftherios Pelechas Athanasios N. Georgiadis Paraskevi V. Voulgari A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review
description	Background: 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. Case: 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.
format	article
author	Alexandros A. Drosos Eleftherios Pelechas Athanasios N. Georgiadis Paraskevi V. Voulgari
author_facet	Alexandros A. Drosos Eleftherios Pelechas Athanasios N. Georgiadis Paraskevi V. Voulgari
author_sort	Alexandros A. Drosos
title	A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review
title_short	A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review
title_full	A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review
title_fullStr	A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review
title_full_unstemmed	A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review
title_sort	not-to-miss cause of severe cervical spine pain in a patient with rheumatoid arthritis: a case-based review
publisher	PCO Convin S.A.
publishDate	2021
url	https://doaj.org/article/4cc00107d2334ff0a2f604efa3fab9de
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A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review

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