OBJECTIVE: To study the prevalence of cervical spine involvement in patients with rheumatoid arthritis, correlating the imaging findings with clinical state. METHODS: A cross-sectional study was carried out at the Federal University of Goiás (UFG) Medical School, with 35 patients, in 2004. The following were diagnosed: ages, use of medications, and clinical aspects (pain and neurology). The laboratory tests performed were erythrocyte sedimentation rate (ESR) and rheumatoid factor, as well as radiography of the cervical column, with frontal, lateral and stress views. The correlation between the different variables and the instabilities were studied by uni- and multivariate logistic regression (p value < 0.05). RESULTS: Of the 35 patients evaluated, 13 (37.1%) presented stable cervical column. Of the 22 patients with instability, six presented more than one. Atlantoaxial instability was found in 15 patients, with an average anterior atlantodental interval of 3.40 mm in the standard lateral X-ray view and 6.54 mm in the lateral view in flexion. Basilar invagination was found in five patients and subaxial subluxation in seven patients. Two thirds of the asymptomatic patients had instabilities. A statistically significant correlation were found between bicipital hyperreflexia and atlantoaxial instability (p = 0.024) and subaxial instability (p = 0.01); also, age on diagnosis was associated with subaxial instability (p = 0.02). CONCLUSIONS: The prevalence of cervical instability was 62.9 % (22/35). The most frequent instabilities were: atlantoaxial instability (42.9 %), subaxial subluxation (20%) and basilar invagination (14.3%). The correlation between instabilities and clinical findings was poor. The patients with subaxial subluxation had onset of the disease at a younger age. Dynamic X-ray was important for the diagnosis of atlantoaxial instability.
Spine; Cervical vertebrae; Rheumatoid arthritis
