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Abstract Number: 1381

Subaxial Cervical Spine Involvement in Symptomatic Rheumatoid Arthritis Patients: Comparison with Cervical Spondylosis

Helena Borrell1, Javier Narváez2, Jose Antonio Narvaez3, Marta Serrallonga4, Carmen Gomez Vaquero1, Eugenia de Lama5, Javier Hernandez Gañan3 and Joan Miquel Nolla1, 1Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain, 2Rheumatology, Hospital Universitario de Bellvitge. Barcelona. Spain, Barcelona, Spain, 3Radiology Department, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain, 4Institut de Diagnostic per la Imatge (IDI), Centre Bellvitge, Barcelona, Spain, 5Radiology, Hospital Universitario de Bellvitge, Barcelona, Spain

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Cervical spine, magnetic resonance imaging (MRI) and rheumatoid arthritis (RA)

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Session Information

Session Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality

Session Type: Abstract Submissions (ACR)

Background/Purpose: To investigate the frequency, location, nature, and clinical significance of subaxial involvement (below C1-C2) in a series of patients with rheumatoid arthritis (RA) and symptomatic involvement of the cervical spine.

Methods: Forty-one patients with RA were studied with cervical spine MRI. A comparative study of the incidence of the different types of subaxial lesions was also performed with respect to 41 age- and sex-matched patients with symptomatic cervical spondylosis.

Results: Stenosis of the spinal canal was found at the subaxial level in 85% of RA patients, and at the atlantoaxial level in 44%. The comparative study with cervical spondylosis revealed significant differences in the type and frequency of subaxial lesions (Table 1). In RA patients, subaxial stenosis seems to be the consequence of both the inflammatory activity of the disease (multilevel vertebral subluxations, inflammatory involvement of cervical spine ligaments, interapophyseal synovitis, bone marrow edema involving the vertebral plates and the interapophyseal joints, spinous process damage, and acquired vertebral blocks) and mechanical-degenerative changes (discopathy and ligamentum flavum hypertrophy).

Unconditional logistic regression analysis was used to identify MRI parameters of subaxial spine involvement associated with the development of neurological dysfunction (Ranawat class II or III). Evidence of alterations in the signal intensity of the spinal cord was the only independent risk factor found for the development of neurological dysfunction (p=.01; OR=11.43), increasing the risk 11-fold. There was a trend toward statistical significance for spinal cord compression (p=.06; OR=3.95). The presence of stenosis of the subaxial spinal canal without evidence of cord compression did not achieve statistical significance (p=.17). These data suggest that neurological manifestations correlate poorly with MRI findings at this level.

Table  1. Frequency  of subaxial lesions in patients with RA and Spondylosis.

RA patients

N = 41

Spondylosis

N = 41

p  value

Stenosis of the subaxial canal

85%

27%

0.0000003

Spinal cord compression

34%

0%

0.0001

Alteration in signal intensity of the spinal cord

       27%          0%

0.0003

Bone marrow edema involving the vertebral plates and the interapophyseal joints

       27%          2%

0.003

Inflammatory involvement of cervical spine ligaments (interspinal ligaments and/or ligamentum nuchae)

       32%          0%

0.0002

Interapophyseal or facet joint synovitis

       17%          0%

0.012

Synovitis of the uncovertebral joints

       0%          0%

–

Spinous process damage (sharpening, erosions, sclerosis or fusion)

       7%          0%        NS

Pannus formation

       0%          0%          –

Discopathy (disk bulging or disruption and/or herniation)

       90%         98%

NS

Ligamentum flavum hypertrophy

       66%         22%

0.0001

Degenerative spinal osteophytosis

       71%         78%

NS

Vertebral subluxation

       24%         5%

0.026

Vertebral ankylosis

       24%         2%

0.007

Sclerosis and/or hypertrophy of the interapophyseal joints

       0%         49%

0.000001

Sclerosis and/or hypertrophy of the uncovertebral joints

       0%         17%

0.0012

 NS = not significant.

Conclusion: Subaxial stenosis seems to be the consequence of both the inflammatory process and mechanical-degenerative changes. Despite its frequency, it was not usually related to the occurrence of myelopathy symptoms, not even in cases with MRI evidence of spinal cord compression. These data seem to indicate a notable behavioral adaptation of this segment


Disclosure:

H. Borrell,
None;

J. Narváez,
None;

J. A. Narvaez,
None;

M. Serrallonga,
None;

C. Gomez Vaquero,
None;

E. de Lama,
None;

J. Hernandez Gañan,
None;

J. M. Nolla,
None.

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