Progression of cervical spine changes in patients with early rheumatoid arthritis.

OBJECTIVE: To evaluate the development and progression of radiological changes of cervical spine in early rheumatoid arthritis (RA).

METHODS: Sixty-seven patients with early RA treated actively with disease modifying antirheumatic drugs were followed prospectively for a mean of 6.5 years. Conventional clinical and laboratory variables were used for measuring disease activity and radiographs of the cervical spine, hands, and feet were taken serially during the followup.

RESULTS: Thirty percent (20/67) of the patients showed radiological evidence of the cervical spine involvement characteristic of RA. Atlantoaxial subluxation was the first type of cervical change to occur, followed by vertical and subaxial subluxations and erosions. Patients with cervical involvement were initially more often rheumatoid factor positive and had higher initial C-reactive protein level than patients without cervical changes. Also, radiological progression of peripheral joints was associated with cervical involvement. HLA-DR4 or B27 positivity did not seem to influence early involvement of cervical spine.

CONCLUSION: Involvement of the cervical spine begins early in RA. Therefore, cervical radiographs should be included in the clinical evaluation during the first years of disease onset, especially in patients with rapid radiological progression in peripheral joints. Aggressive therapy is emphasized in these patients, including the conservative treatment of cervical spine.