Date: Monday, November 8, 2021
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).
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 January 27, 2023.
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