ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1210

Frequency of Anterior Atlanto-Axial Subluxation in Patients with Rheumatoid Arthritis

Joan Manuel Dapeña1, Eliana Serrano1, Silvana Perez1, Juan Manuel Bande1, Belen Barrios1, María Alejandra Medina1, Diana Klajn1, Jose Caracciolo1, Mariana Benegas2, Analía Dellepiane3, Julieta Silvana Morbiducci4, Maria Cecilia Castro4, Anastasia Secco4, Julia Sosa5, María Paula Kohan6, María Noelia Bersano7, Yamila Chichotky8, José Luis Velasco Zamora9, Víctor Leonardo Yohena10, Laura Rocca10, analia alvarez11, Karin Ingrid Kirmayr12, Galo Saltos Farinango13, Oscar Rillo14, María de los Ángeles Correa15, Analía Verónica Bohr16, Adriana Pérez Dávila17, Nicolas Perez18 and Silvia Papasidero1, 1Hospital General de Agudos Dr. Enrique Tornú, Buenos Aires, Argentina, 2Sanatorio Dr. Julio Méndez, Buenos Aires, Argentina, 3Centro de Especialidades Médicas Caseros, Casilda, Santa Fé, Casilda, Santa Fé, Argentina, 4Hospital General de Agudos Bernardino Rivadavia, Buenos Aires, Argentina, 5Hospital Municipal Dr. Raúl F. Larcade, San Miguel, Buenos Aires, Argentina, 6Hospital Municipal Dr. Raúl F. Larcade, San Miguel, Pilar, Argentina, 7Hospital Provincial de Rosario, Santa Fé, Argentina, 8Reumatología al Sur, Berazategui, Buenos Aires, Argentina, 9Reumatología al Sur, Berazategui, Berazategui, Argentina, 10Hospital General de Agudos Dr. José Penna, Buenos Aires, Buenos Aires, Argentina, 11Hospital General de Agudos Dr. José Penna, Buenos Aires, Argentina, 12Sanatorio San Carlos, Bariloche, Argentina, 13Hospital General de Agudos Dr. Ignacio Pirovano, Buenos Aires, Argentina, 14Hospital I. Pirovano, Buenos Aires, Argentina, 15Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, 16Hospital de Rehabilitación M. Rocca, Ciudad autónoma de Buenos Aires, Argentina, 17Hospital de Rehabilitación M. Rocca, Buenos Aires, Argentina, 18Instituto de Investigaciones Médicas Alfredo Lanari, Buenos Aires, Argentina

Meeting: ACR Convergence 2021

Keywords: , ,

Session Information

Date: Monday, November 8, 2021

Title: RA – Diagnosis, Manifestations, & Outcomes Poster III: Prediction, Biomarkers, & Treatment Response (1196–1222)

Session Type: Poster Session C

Session Time: 8:30AM-10:30AM

Background/Purpose: According to some series, cervical spine is the second most affected region in Rheumatoid arthritis (RA). Cervical involvement was reported in 80% of RA patients, being anterior Atlanto-Axial subluxation (aAAS) the most frequent one. Other less frequent types are Subaxial Subluxation (SAS), posterior Atlanto-Axial subluxation (pAAS), lateral Atlanto-Axial subluxation (LAAS) and Atlanto-Axial impaction (AAI). The aim of this study was to describe the frequency of aAAS in a cohort of patients with RA and to evaluate its association with demographic and disease characteristics.

Methods: Multicenter, observational, cross-sectional, descriptive, and analytical study. Patients ≥ 18 years old with diagnosis of RA (ACR-EULAR 2010) and at least one flexion lateral cervical spine radiograph were included. aAAS was defined when anterior Atlanto-Axial distance (aAAD) was ≥ 3mm. The other forms of cervical spine involvement were also reported. All the radiographs were assessed by 3 experienced rheumatologists. Statistical analysis: Descriptive statistics was done. Sociodemographic and disease characteristics of patients with and without aAAS were compared using Student’s T test, Chi2 and Fisher’s exact test. The aAAD was assessed according to disease characteristics, symptom presence, and disease duration at the time of diagnosis of the aAAS using Spearman correlation, Student’s T test, Kruskal Wallis and Wilcoxon test.

Results: A total of 295 patients from 13 centers were included. Sociodemographic and RA characteristics are shown in Table 1. The frequency of aAAS was 25.4% and the average aAAD 4.5 mm (SD 2.4). Their frequency and that of the other types of cervical spine involvement can be observed in figure 1. The median disease duration at the time of diagnosis of aAAS was 128 months (IQR 82.5-196). The most frequent reported symptom was radicular pain in 20% of patients, and 6% of them required surgical intervention. Patients with aAAS had longer disease duration (119 months [45-174] vs 76 [43-102] months, p < 0.05) and higher frequency of extra-articular manifestations (97.3% vs. 40.9%, p < 0.001). The frequency of pAAS was much higher in the group with aAAS (8.6% vs. 0.5%, p < 0.001). In patients with aAAS, the median of the aAAD was higher in symptomatic patients (5 mm [IQR 3.7-6.5] vs 3 mm [IQR 3-5], p=0.011), and it was particularly associated with radicular pain (5 mm [IQR 4-7] vs 3 mm [IQR 3-5], p=0.009).

Conclusion: The frequency of aAAS in this cohort of RA patients was 25.4%. The prevalence of pAAS was much higher in the group with aAAS. The aAAD was greater than 5 mm in patients with neurological symptoms (especially with radicular pain).

Table 1.jpeg”Table 1. Sociodemographic and RA characteristics.

Figure 1.jpeg”Figure 1. Frecuency of cervical spine involvement

Disclosures: J. Dapeña, None; E. Serrano, None; S. Perez, None; J. Bande, None; B. Barrios, None; M. Medina, None; D. Klajn, None; J. Caracciolo, None; M. Benegas, None; A. Dellepiane, None; J. Morbiducci, None; M. Castro, None; A. Secco, None; J. Sosa, None; M. Kohan, None; M. Bersano, None; Y. Chichotky, None; J. Velasco Zamora, None; V. Yohena, None; L. Rocca, None; a. alvarez, None; K. Kirmayr, None; G. Saltos Farinango, None; O. Rillo, None; M. Correa, None; A. Bohr, None; A. Pérez Dávila, None; N. Perez, None; S. Papasidero, None.

To cite this abstract in AMA style:

Dapeña J, Serrano E, Perez S, Bande J, Barrios B, Medina M, Klajn D, Caracciolo J, Benegas M, Dellepiane A, Morbiducci J, Castro M, Secco A, Sosa J, Kohan M, Bersano M, Chichotky Y, Velasco Zamora J, Yohena V, Rocca L, alvarez a, Kirmayr K, Saltos Farinango G, Rillo O, Correa M, Bohr A, Pérez Dávila A, Perez N, Papasidero S. Frequency of Anterior Atlanto-Axial Subluxation in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/frequency-of-anterior-atlanto-axial-subluxation-in-patients-with-rheumatoid-arthritis/. Accessed .

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