The impact of rheumatoid arthritis οn atlantoaxial stability and its relevant complications
Keywords:
rheumatoid arthritis, cervical spine, pathophysiology, treatmentAbstract
Rheumatoid arthritis (RA) is chronic, symmetric, inflammatory, peripheral polyarthritis of unknown etiology, typically leading to joint destruction through bony and cartilaginous erosions. Cervical spine is commonly engaged in the clinical frame of rheumatoid arthritis, regarding almost exclusively the upper third of it. Electronic databases PubMed, Scopus, and Google Scholar were searched using the following keywords: “rheumatoid arthritis,” “cervical spine,” “pathophysiology,” and “treatment,” with the logical operator ‘AND’ utilized between search terms. Additionally, phrases such as “rheumatoid arthritis in cervical spine” and “rheumatoid arthritis pathophysiology” were used for the search. Supplementary searches were performed to identify any additional pertinent articles not covered in the initial search. Through this review we intend to enlighten the presence of cervical myelopathy as part of rheumatoid arthritis, describing clinical features, imaging techniques and laboratorial examinations as well as treatment options available for this group of patients.
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References
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6. Oda T, Fujiwara K, Yonenobu K, et al. Natural course of cervical spine lesions in rheumatoid arthritis. Spine (Phila Pa 1976) 1995;20:1128–35.
7. Paus AC, Steen H, Røislien J, Mowinckel P, Teigland High mortality rate in rheumatoid arthritis with subluxation of the cervical spine: a cohort study of operated and nonoperated patients. J.Spine (Phila Pa 1976). 2008 Oct 1;33(21):2278-83. doi: 10.1097/BRS.0b013e31817f1a17. PMID:18784629
8. A. W. B. Heywood, I. D. Learmonth, and M. Thomas, “Cervical spine instability in rheumatoid arthritis,” JBJS—Series B, 1988;70(5):702–07.
9. Lipson SJ. “Rheumatoid arthritis in the cervical spine,” Clinical Orthopaedics and Related Research, 1989;239:121–27.
10. B. R. Wasserman, R. Moskovich, and A. E. Razi, “Rheumatoid arthritis of the cervical spine—clinical considerations,” Bulletin of the NYU Hospital for Joint Diseases, vol. 69, no. 2, pp. 136–148, 2011.
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22. Grob D, Würsch R, Grauer W, Sturzenegger J, Dvorak J. Atlantoaxial fusion and retrodental pannus in rheumatoid arthritis. Spine (Phila Pa 1976) 1997; 22:1580-84
23. Boden SD, Dodge LD, Bohlman HH, Rechtine GR. Rheumatoid arthritis of the cervical spine. Along-term analysis with predictors of paralysis and recovery. J Bone Joint Surg Am 1993;75:1282-97
24. Nakano KK, Schoene WC, Baker RA, Dawson DM. The cervical myelopathy associated with rheumatoid arthritis: analysis of patients, with 2 postmortem cases. Ann Neurol 1978;3:144-151
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29. Menezes AH, Van Gilder JC, Clark CR, el-Khoury G. Odontoid upward migration in rheumatoid arthritis. An analysis of 45 patients with “cranial settling”. J Neurosurg 1985; 63:500-09
30. Goel A. Retro‑odontoid mass: An evidence of craniovertebral instability. J Craniovert Junc Spine 2015;6:6‑7
31. Abumi K, Kaneda K, Shono Y, Fujiya M One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg (Spine 1) 1999;90:19-26
32. Grob D, Crisco JJ 3rd, Panjabi MM, Wang P, Dvorak J. Biomechanical evaluation of four different posterior atrantoaxial fixation techniques. Spine 1992;17:480–90
33. Kotani Y, Cunningham BW, Abumi K, McAfee PC. Biomechanical analysis of cervical stabilization systems: an assessment of transpedicular screw fixation in the cervical spine. Spine 1994;17:2529-39
34. Magerl F, Seemann PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Kehr P, Weidner A (eds) Cervical spine I. Springer, Berlin Heidelberg New York, 1997;322–327
35. Takahashi J, Shono Y, Nakamura I, Hirabayashi H, Kamimura M, Ebara S, Kato H. Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis. Eur Spine J. 2007;16(4):485-94
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37. Goel A, Pareikh S, Sharma P. Atlantoaxial joint distraction for treatment of basilar invagination secondary to rheumatoid arthritis. Neurol India 2005;53:238‑40
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40. Sunahara N, Matsunaga S, Mori T, Ijiri K, Sakou T. Clinical course of conservatively managed rheumatoid arthritis patients with myelopathy. Spine 1997;22:2603-07
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42. Howe CR, Gardner GC, Kadel NJ. Perioperative medication management for the patient with rheumatoid arthritis. J Am Acad Orthop Surg 2006;14:544-51
43. Gerster JC, Bossy R, Dudler J. Bone non-union after osteotomy in patients treated withmethotrexate. J Rheumatol 1999;26:2695-97
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46. Ryan Khanna, Brian J. Dlouhy, Zachary A. Smith, Sandi K. Lam, Tyler R. Koski, Nader S. Dahdaleh J. The impact of steroids, methotrexate, and biologics on clinical and radiographic outcomes in patients with rheumatoid arthritis undergoing fusions at the craniovertebral junction. Craniovertebr Junction Spine. 2015;6(2):60–64. doi: 10.4103/0974-8237.156044 PMCID: PMC4426523
47. Clarke MJ, Cohen-Gadol AA, Ebersold MJ, Cabanela ME. Long-term incidence of subaxial cervical spine instability following cervical arthrodesis surgery in patients with rheumatoid arthritis. Surg Neurol 2006;66:136-40.
48. Schmitt-Sody M, Kirchhoff C, Buhmann S, Metz P, Birkenmaier C, Troullier H, Jansson V, Veihelmann A. Timing of cervical spine stabilization and outcome in patients with rheumatoid arthritis. Int Orthop 2008;32:511-51
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51. Agarwal AK, Peppelman WC, Kraus DR, Pollock BH, Stolzer BL, Eisenbeis CH, Donaldson WF. Recurrence of cervical spine instability in rheumatoid arthritis following previous fusion: can disease progression be prevented by early surgery? J Rheumatol 1992;19:1364-70
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2. Wasserman B. R., Moskovich R., Razi A. E. Rheumatoid arthritis of the cervical spine—clinical considerations. Bulletin of the NYU Hospital for Joint Diseases. 2011;69(2):136–148.
3. Shah A., St. Clair E. Rheumatoid arthritis. In: Longo D. L., Fauci A. S., Kasper D. L., Hauser S. L., Jameson J., Loscalzo J., editors. Harrison's Principles of Internal Medicine. 18th. chapter 321. New York, NY, USA: McGraw-Hill; 2012.
4. Delamarter RB, Bohlman HH. Postmortem osseous and neuropathologic analysis of the rheumatoid cervical spine. Spine. 1994;19(20):2267–74. doi: 10.1097/00007632-199410150-00004.
5. Neva MH, Häkkinen A, Mäkinen H, Hannonen P, Kauppi M, Sokka T. High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery. Annals of the Rheumatic Diseases 2006;65:884-88. doi.org/10.1136/ard.2005.042135
6. Oda T, Fujiwara K, Yonenobu K, et al. Natural course of cervical spine lesions in rheumatoid arthritis. Spine (Phila Pa 1976) 1995;20:1128–35.
7. Paus AC, Steen H, Røislien J, Mowinckel P, Teigland High mortality rate in rheumatoid arthritis with subluxation of the cervical spine: a cohort study of operated and nonoperated patients. J.Spine (Phila Pa 1976). 2008 Oct 1;33(21):2278-83. doi: 10.1097/BRS.0b013e31817f1a17. PMID:18784629
8. A. W. B. Heywood, I. D. Learmonth, and M. Thomas, “Cervical spine instability in rheumatoid arthritis,” JBJS—Series B, 1988;70(5):702–07.
9. Lipson SJ. “Rheumatoid arthritis in the cervical spine,” Clinical Orthopaedics and Related Research, 1989;239:121–27.
10. B. R. Wasserman, R. Moskovich, and A. E. Razi, “Rheumatoid arthritis of the cervical spine—clinical considerations,” Bulletin of the NYU Hospital for Joint Diseases, vol. 69, no. 2, pp. 136–148, 2011.
11. W. E. Krauss, J. M. Bledsoe, M. J. Clarke, E. W. Nottmeier, and M. A. Pichelmann, “Rheumatoid arthritis of the craniovertebral junction,” Neurosurgery 2010;66(3):A83-A95.
12. Shen FH, Samartzis D, Jenis LG, An HS. Rheumatoid arthritis: evaluation and surgical management of the cervical spine. Spine J 2004;4:689-700. https://doi.org/10.1016/j.spinee.2004.05.001
13. Siempis T, Tsakiris Ch, Zikou A, George A. Alexiou GA, Voulgaris S, Argyropoulou MI. Radiological assessment and surgical management of cervical spine involvement in patients with rheumatoid arthritis. Rheumatol Int. 2023;43(2):195-208. doi: 10.1007/s00296-022-05239-5 PMCID: PMC9898347
14. Casey ATH, Crockard HA, Geddes JF, Stevens J. Vertical translocation: the enigma of the disappearing atlantodens interval in patients with myelopathy and rheumatoid arthritis. Part I. Clinical, radiological, and neuropathological features. J Neurosurg 1997;87:856-862.https://doi.org/10.3171/jns.1997.87.6.085
15. Mukerji N, Todd NV. Cervical Myelopathy in Rheumatoid Arthritis Neurol Res Int. 2011; 2011:153628. Published online 2011 Nov 22. doi: 10.1155/2011/153628 PMCID: PMC3238417
16. Riew KD, Hilibrand AS, Palumbo MA, Sethi N, Bohlman HH. “Diagnosing basilar invagination in the rheumatoid patient: the reliability of radiographic criteria,” JBJS-Series A, 2001;83(2):194-200.
17. Kotecki M, Gasik R, Głuszko P, Sudoł-Szopińska I. Radiological Evaluation of Cervical Spine Involvement in Rheumatoid Arthritis: A Cross-Sectional Retrospective Study. J Clin Med. 2021;10(19):4587. Published online 2021 Oct 5. doi: 10.3390/jcm10194587 PMCID:PMC8509796
18. Kotecki M, Sotniczuk M, Gietka P, Gasik R, Sudoł-Szopińska I. Imaging of cervical spine involvement in inflammatory arthropathies: a review. Pol J Radiol. 2021;86:e620–e629. Published online 2021 Nov 20. doi: 10.5114/pjr.2021.111363 PMCID: PMC8652349
19. Bouchaud-Chabot A, Lioté F. Cervical spine involvement in rheumatoid arthritis. A review. Joint Bone Spine 2002;69(2):141-54. doi: 10.1016/s1297-319x(02)00361-5.
20. MacDowall A, Barany L Bodon G. Surgical treatment outcome on a national cohort of 176 patients with cervical manifestation of rheumatoid arthritis. J Craniovertebr Junction Spine. 2021;12(3):248–56. Published online 2021 Sep 8. doi:10.4103/jcvjs.jcvjs_200_20 PMCID: PMC8501822
21. Lorber A Pearson CM, Rene RM. Osteolytic vertebral lesions as a manifestation of rheumatoid arthritis and related disorders. Arthritis Rheum 1961;4:514-532
22. Grob D, Würsch R, Grauer W, Sturzenegger J, Dvorak J. Atlantoaxial fusion and retrodental pannus in rheumatoid arthritis. Spine (Phila Pa 1976) 1997; 22:1580-84
23. Boden SD, Dodge LD, Bohlman HH, Rechtine GR. Rheumatoid arthritis of the cervical spine. Along-term analysis with predictors of paralysis and recovery. J Bone Joint Surg Am 1993;75:1282-97
24. Nakano KK, Schoene WC, Baker RA, Dawson DM. The cervical myelopathy associated with rheumatoid arthritis: analysis of patients, with 2 postmortem cases. Ann Neurol 1978;3:144-151
25. Santavirta S, Slätis P, Kankaanpää U, Sandelin J, Laasonen E. Treatment of the cervical spine in rheumatoid arthritis. J Bone Joint Surg Am 1988;70:658-67
26. Crockard HA. Surgical management of cervical rheumatoid problems. Spine (Phila Pa 1976) 1995;20: 2584-90
27. Mallory GW, Halasz SR, Clarke MJ. Advances in the treatment of cervical rheumatoid: Less surgery and less morbidity. World J Orthop 2014;5(3): 292-303
28. van Asselt KM, Lems W, Bongartz E, Hamburger H, Drossaers-Bakker K, Bijkmans, van Soesbergen RM. Outcome of cervical spine surgery in patients with rheumatoid arthritis. Ann Rheum Dis. 2001;60(5):448–452. doi: 10.1136/ard.60.5.448 PMCID: PMC1753638
29. Menezes AH, Van Gilder JC, Clark CR, el-Khoury G. Odontoid upward migration in rheumatoid arthritis. An analysis of 45 patients with “cranial settling”. J Neurosurg 1985; 63:500-09
30. Goel A. Retro‑odontoid mass: An evidence of craniovertebral instability. J Craniovert Junc Spine 2015;6:6‑7
31. Abumi K, Kaneda K, Shono Y, Fujiya M One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg (Spine 1) 1999;90:19-26
32. Grob D, Crisco JJ 3rd, Panjabi MM, Wang P, Dvorak J. Biomechanical evaluation of four different posterior atrantoaxial fixation techniques. Spine 1992;17:480–90
33. Kotani Y, Cunningham BW, Abumi K, McAfee PC. Biomechanical analysis of cervical stabilization systems: an assessment of transpedicular screw fixation in the cervical spine. Spine 1994;17:2529-39
34. Magerl F, Seemann PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Kehr P, Weidner A (eds) Cervical spine I. Springer, Berlin Heidelberg New York, 1997;322–327
35. Takahashi J, Shono Y, Nakamura I, Hirabayashi H, Kamimura M, Ebara S, Kato H. Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis. Eur Spine J. 2007;16(4):485-94
36. Goel A, Sharma P. Craniovertebral realignment for basilar invagination and atlantoaxial dislocation secondary to rheumatoid arthritis. Neurol India 2004;52:338‑41
37. Goel A, Pareikh S, Sharma P. Atlantoaxial joint distraction for treatment of basilar invagination secondary to rheumatoid arthritis. Neurol India 2005;53:238‑40
38. Hamblen D. Surgical management of rheumatoid arthritis: The cervical spine. In: Postgraduate Textbook of Clinical Orthopaedics. Bristol: Wright;1983
39. John L. Gillick, John Wainwright, Kaushik Das. Rheumatoid Arthritis and the Cervical Spine: A Review on the Role of Surgery Int J Rheumatol. 2015; 2015: 252456. doi: 10.1155/2015/252456 PMCID: PMC4553335
40. Sunahara N, Matsunaga S, Mori T, Ijiri K, Sakou T. Clinical course of conservatively managed rheumatoid arthritis patients with myelopathy. Spine 1997;22:2603-07
41. Bydon M, Macki M, Qadi M, De la Garza-Ramos R, Kosztowski TA, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Bydon A. Regression of an atlantoaxial rheumatoid pannus following posterior instrumented fusion. Clin Neurol Neurosurg 2015;137:28-33
42. Howe CR, Gardner GC, Kadel NJ. Perioperative medication management for the patient with rheumatoid arthritis. J Am Acad Orthop Surg 2006;14:544-51
43. Gerster JC, Bossy R, Dudler J. Bone non-union after osteotomy in patients treated withmethotrexate. J Rheumatol 1999;26:2695-97
44. Giles JT, Bartlett SJ, Gelber AC, Nanda S, Fontaine K, Ruffing V et al. Tumor necrosis factor inhibitor therapy and risk of serious postoperative orthopedic infection in rheumatoid arthritis. Arthritis Rheum 2006;55:333-37
45. Miyamoto H, Sumi M, Uno K. Outcome of surgery for rheumatoid cervical spine at one institute over three decades. Spine J 2013;13:1477-84
46. Ryan Khanna, Brian J. Dlouhy, Zachary A. Smith, Sandi K. Lam, Tyler R. Koski, Nader S. Dahdaleh J. The impact of steroids, methotrexate, and biologics on clinical and radiographic outcomes in patients with rheumatoid arthritis undergoing fusions at the craniovertebral junction. Craniovertebr Junction Spine. 2015;6(2):60–64. doi: 10.4103/0974-8237.156044 PMCID: PMC4426523
47. Clarke MJ, Cohen-Gadol AA, Ebersold MJ, Cabanela ME. Long-term incidence of subaxial cervical spine instability following cervical arthrodesis surgery in patients with rheumatoid arthritis. Surg Neurol 2006;66:136-40.
48. Schmitt-Sody M, Kirchhoff C, Buhmann S, Metz P, Birkenmaier C, Troullier H, Jansson V, Veihelmann A. Timing of cervical spine stabilization and outcome in patients with rheumatoid arthritis. Int Orthop 2008;32:511-51
49. Ranawat CS, O’Leary P, Pellicci P, Tsairis P, Marchisello P, Dorr L. Cervical spine fusion in rheumatoid arthritis. J Bone Joint Surg Am 1979;61:1003-10
50. Ronkainen A, Niskanen M, Auvinen A, Aalto J, Luosujärvi R. Cervical spine surgery in patients with rheumatoid arthritis: longterm mortality and its determinants. J Rheumatol 2006;33:517-22
51. Agarwal AK, Peppelman WC, Kraus DR, Pollock BH, Stolzer BL, Eisenbeis CH, Donaldson WF. Recurrence of cervical spine instability in rheumatoid arthritis following previous fusion: can disease progression be prevented by early surgery? J Rheumatol 1992;19:1364-70
52. Siril T. Holmberg, Agnete M. Gulati, Tonje Okkenhaug Johansen, Øyvind O. Salvesen, Vetle Vangen Lønne, Tore K. Solberg, Erling A. Tronvik, Øystein P. Nygaard, Sasha Gulati. Surgery for degenerative cervical myelopathy in patients with rheumatoid arthritis and ankylosing spondylitis: a nationwide registry-based study with patient-reported outcomes. Acta Neurochir (Wien)2022;164(12):3165-71.doi: 10.1007/s00701-022-05382-9 PMCID: PMC9705458
53. Bernstein DN, Kurucan E, Menga EN, Molinari RW, Rubery PT, Mesfin A. Comparison of adult spinal deformity patients with and without rheumatoid arthritis undergoing primary non-cervical spinal fusion surgery: a nationwide analysis of 52,818 patients. Spine J. 2018;18:1861-66
54. Umekawa M, Takai K, Taniguchi M. Complications of spine surgery in elderly Japanese patients: implications for future of world population aging. Neurospine. 2019;16:780-88
55. Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77:217–22
56. Somani S, di Capua J, Kim JS, Phan K, Lee NJ, Kothari P, et al. ASA classification as a risk stratification tool in adult spinal deformity surgery: a study of 5805 patients. Glob Spine J. 2017;7:719-26
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