Atlanto-axial lesions in patients with rheumatoid arthritis – observational study

Background: Cervical spine inflammatory lesions affect 25-80% of patients with rheumatoid arthritis (RA). Most of the studies emphasize the lack of correlation between patients’ complaints and radiological findings.
Objectives: The aim of this study was to evaluate deterioration of atlanto-axial lesions and to define the possible relation between self-reported symptoms and radiological progression of these lesions in RA patients.
Material and methods: 100 RA patients were included in the study. The patients were evaluated at the beginning of the study and after 5 years. The first evaluation consisted of: a 7-item questionnaire about subjective symptoms of cervical pain and myelopathy, neurological examination performed by an independent neurologist and dynamic radiological examination of the cervical spine supplemented by computed tomography and/or magnetic resonance imaging. After five years the same questionnaire, neurological examination and X-ray were repeated.
Results: At the beginning of the study half of the patients revealed atlanto-axial lesions. No correlation between self-reported symptoms and radiological findings were found. The second evaluation included 47 enrolled patients. Deterioration in radiological images was found in 23.4% of them (10.6% progression and 12.8% new lesions). The patients with deterioration had sustained high disease activity (DAS28) compared with the patients without, and more often developed radiological changes of stage III or IV according to Steinbrocker (p < 0.05). The group with deterioration had a tendency to score more points on the second questionnaire, unlike the group without progression (p = 0.09).
Conclusions: The risk of progressive atlanto-axial lesions is higher in patients with high disease activity. Repeating the self-assessment questionnaire can be useful in making a decision of further radiological examination in RA patients.