Risk of cervical myelopathy in rheumatoid arthritis patients with neck pain

Background: Cervical spine (CS) evaluation in rheumatoid arthritis (RA) is challenging since subtle neurological insult is usually masked by the severe peripheral joint affection or muscle atrophy. Neglected CS lesions could end up with cervical myelopathy. Magnetic resonance imaging (MRI) has been...

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Autores principales:	Marina W. Gerges, Eman A. Hafez, Reem A. Habeeb, Hossam M. Sakr, Nashwa A. Morshedy, Rasha Hassan
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	Cervical Myelopathy MRI Rheumatoid Arthritis Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/7f21977e06fe4dc4a359126f97e404d7
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spelling	oai:doaj.org-article:7f21977e06fe4dc4a359126f97e404d72021-11-12T04:27:06ZRisk of cervical myelopathy in rheumatoid arthritis patients with neck pain1110-116410.1016/j.ejr.2021.10.006https://doaj.org/article/7f21977e06fe4dc4a359126f97e404d72022-04-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S1110116421000946https://doaj.org/toc/1110-1164Background: Cervical spine (CS) evaluation in rheumatoid arthritis (RA) is challenging since subtle neurological insult is usually masked by the severe peripheral joint affection or muscle atrophy. Neglected CS lesions could end up with cervical myelopathy. Magnetic resonance imaging (MRI) has been the modality of choice in assessing CS in RA. Aim of the work: To evaluate CS in RA using MRI and detect the risk factors for its involvement. Patients and methods: Forty RA patients with neck pain were assessed using disease activity score (DAS28), Ranawat classification of rheumatoid myelopathy, simple erosion narrowing score (SENS), bilateral hand and wrist musculoskeletal ultrasound (MSKUS) for early erosion detection and CS MRI. Results: The mean age of patients was 44.3 ± 10.1 years, disease duration 7.9 ± 6.6 years and the DAS28 was 4.8 ± 1.6. 70% of patients were in Ranawat class I, 30% in class II, and none in class III. 70% of patients had CS lesions where synovitis occurred in 67.5% of patients, odontoid erosions in 15%, atlanto-axial marrow edema in 5%, atlanto-occipital marrow edema in 5% and none had atlanto-axial subluxation (AAS), subaxial subluxation (SAS), spinal cord/brain stem compression. CS involvement was significantly related to peripheral joint erosion, high SENS and positive RF (p = 0.01, p < 0.0001, p < 0.0001 respectively). Conclusion: CS involvement is remarkable in RA especially in those with peripheral joint erosions, high SENS and positive RF. RA patients with persistent neck pain, even in absence of objective neurological deficit should be evaluated early for detection and management of CS lesions before irreversible neurological damage takes place.Marina W. GergesEman A. HafezReem A. HabeebHossam M. SakrNashwa A. MorshedyRasha HassanElsevierarticleCervicalMyelopathyMRIRheumatoidArthritisImmunologic diseases. AllergyRC581-607ENEgyptian Rheumatologist, Vol 44, Iss 2, Pp 115-119 (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cervical Myelopathy MRI Rheumatoid Arthritis Immunologic diseases. Allergy RC581-607
spellingShingle	Cervical Myelopathy MRI Rheumatoid Arthritis Immunologic diseases. Allergy RC581-607 Marina W. Gerges Eman A. Hafez Reem A. Habeeb Hossam M. Sakr Nashwa A. Morshedy Rasha Hassan Risk of cervical myelopathy in rheumatoid arthritis patients with neck pain
description	Background: Cervical spine (CS) evaluation in rheumatoid arthritis (RA) is challenging since subtle neurological insult is usually masked by the severe peripheral joint affection or muscle atrophy. Neglected CS lesions could end up with cervical myelopathy. Magnetic resonance imaging (MRI) has been the modality of choice in assessing CS in RA. Aim of the work: To evaluate CS in RA using MRI and detect the risk factors for its involvement. Patients and methods: Forty RA patients with neck pain were assessed using disease activity score (DAS28), Ranawat classification of rheumatoid myelopathy, simple erosion narrowing score (SENS), bilateral hand and wrist musculoskeletal ultrasound (MSKUS) for early erosion detection and CS MRI. Results: The mean age of patients was 44.3 ± 10.1 years, disease duration 7.9 ± 6.6 years and the DAS28 was 4.8 ± 1.6. 70% of patients were in Ranawat class I, 30% in class II, and none in class III. 70% of patients had CS lesions where synovitis occurred in 67.5% of patients, odontoid erosions in 15%, atlanto-axial marrow edema in 5%, atlanto-occipital marrow edema in 5% and none had atlanto-axial subluxation (AAS), subaxial subluxation (SAS), spinal cord/brain stem compression. CS involvement was significantly related to peripheral joint erosion, high SENS and positive RF (p = 0.01, p < 0.0001, p < 0.0001 respectively). Conclusion: CS involvement is remarkable in RA especially in those with peripheral joint erosions, high SENS and positive RF. RA patients with persistent neck pain, even in absence of objective neurological deficit should be evaluated early for detection and management of CS lesions before irreversible neurological damage takes place.
format	article
author	Marina W. Gerges Eman A. Hafez Reem A. Habeeb Hossam M. Sakr Nashwa A. Morshedy Rasha Hassan
author_facet	Marina W. Gerges Eman A. Hafez Reem A. Habeeb Hossam M. Sakr Nashwa A. Morshedy Rasha Hassan
author_sort	Marina W. Gerges
title	Risk of cervical myelopathy in rheumatoid arthritis patients with neck pain
title_short	Risk of cervical myelopathy in rheumatoid arthritis patients with neck pain
title_full	Risk of cervical myelopathy in rheumatoid arthritis patients with neck pain
title_fullStr	Risk of cervical myelopathy in rheumatoid arthritis patients with neck pain
title_full_unstemmed	Risk of cervical myelopathy in rheumatoid arthritis patients with neck pain
title_sort	risk of cervical myelopathy in rheumatoid arthritis patients with neck pain
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/7f21977e06fe4dc4a359126f97e404d7
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Risk of cervical myelopathy in rheumatoid arthritis patients with neck pain

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