NATURAL COURSE OF CERVICAL-SPINE LESIONS IN RHEUMATOID-ARTHRITIS

被引:118
作者
ODA, T
FUJIWARA, K
YONENOBU, K
AZUMA, B
OCHI, T
机构
[1] HOSHIGAOKA KOSEINENKIN HOSP,DEPT ORTHOPAED SURG,HIRAKATA,OSAKA,JAPAN
[2] KANSAI ROSAI HOSP,DEPT ORTHOPAED SURG,AMAGASAKI,HYOGO,JAPAN
关键词
CERVICAL SPINE; DISEASE SUBSET; NATURAL COURSE; RHEUMATOID ARTHRITIS;
D O I
10.1097/00007632-199505150-00004
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design. This study analyzed the natural course of cervical spine involvement in rheumatoid arthritis by serial radiographs. Objectives. The purpose waste determine the pattern of progression of cervical spine lesions in rheumatoid arthritis:and predictors for the extent of progression. Summary of Background Data. Subluxation frequently occurs as a result of rheumatoid involvement of the cervical spine. It may be severe in patients with mutilans deformities in the hands and feet. The extent of progression in a given patient is still unpredictable, Methods, Serial cervical radiographs in 49 patients with rheumatoid arthritis were analyzed. The extent of progression was evaluated by rheumatoid arthritis subset defined previously, which reflected the final extent of joint erosion in this systemic disease and could be roughly classified during early stages of the disease. Results. In the upper cervical spine, reducible anterior atlantoaxial subluxation occurred first. Vertical subluxation of the axis appeared next. Irreducible change of preceding anterior atlantoaxial subluxation was a sign of the start of vertical subluxation; In subaxial lesion, subluxation occurred less frequently (22.4%) than upper cervical lesion (77.6%). the extent of progression was different-with the rheumatoid arthritis subset. In the upper cervical spine, none of the subset with least erosive:disease developed vertical subluxation, whereas 52% of the subset with more erosive disease and 88% of the subset with mutilating disease advanced to vertical subluxation. The extent of progression was well correlated with the number of joints with erosion. Subaxial subluxation was often seen and became irreducible In mutilating disease and more erosive disease, but not in least erosive disease. Conclusions, A progressive pattern of the upper cervical subluxations was clarified. That is, upper cervical lesions progressed from reducible anterior atlantoaxial subluxation to irreducible anterior atlantoaxial subluxation with vertical subluxation. This extent of progression was different with the rheumatoid arthritis subset, which was also related to the development of subaxial subluxation. The most aggressive arthritis classification, a subset with mutilating disease, had the more severe subluxation in both upper and subaxial cervical spine.
引用
收藏
页码:1128 / 1135
页数:8
相关论文
共 25 条
[11]  
Mathews J.A., Atlanto-axial subluxation in rheumatoid arthritis. A 5-year follow-up study, Ann Rheum Dis, 33, pp. 526-531, (1974)
[12]  
Meijers K., Van Beusekom G., Luyendijk W., Duijfjes F., Dislocation of the cervical spine with cord compression in rheumatoid arthritis, J Bone Joint Surg [Br], 56, pp. 668-680, (1974)
[13]  
Morizono Y., Sakou T., Kawaida H., Upper cervical in-volvement in rheumatoid arthritis, Spine, 12, pp. 721-725, (1987)
[14]  
Ochi T., Iwase R., Yoneinasu K., Et al., Natural course of joint destruction and fluctuation of serum Clq levels in pa¬tients with rheumatoid arthritis, Arthritis Rheum, 31, pp. 37-43, (1988)
[15]  
Pellicci P.M., Ranawat C.S., Tsairis P., Bryan W.J., A prospective study of the progression of rheumatoid arthritis of the cervical spine, J Bone Joint Surg [Am], 63, pp. 342-350, (1981)
[16]  
Rana N.A., Natural history of atlanto-axial subluxation in rheumatoid arthritis, Spine, 14, pp. 1054-1056, (1989)
[17]  
Ranawat C.S., O'Leary P., Pellicci P., Tsairis P., Marchisello P., Dorr L., Cervical spine fusion in rheumatoid arthritis, J Bone Joint Surg [Am], 61, pp. 1003-1010, (1979)
[18]  
Rasker J.J., Cosh J.A., Radiological study of cervical spine and hand in patients with rheumatoid arthritis of 15 years’ duration: An assessment of the effects of corticosteroid treatment, Ann Rheum Dis, 37, pp. 529-535, (1978)
[19]  
Santavirta S., Kankaanpaa U., Sandelin J., Laasonen E., Konttinen Y.T., Slatis P., Evaluation of patients with rheumatoid cervical spine, Scand J Rheumatol, 16, pp. 9-16, (1987)
[20]  
Santavirta S., Slatis P., Kankaanpaa U., Sandelin J., Laasonen E., Treatment of the cervical spine in rheumatoid arthri¬tis, J Bone Joint Surg [Am], 70, pp. 658-667, (1988)