ab21204

Atlantoaxial disorders in rheumatoid arthritis associate with the destruction of peripheral and shoulder joints, and decreased bone mineral density

M.H Neva¹, A. Kotaniemi², K. Kaarela², J.T. Lehtinen⁴, E.A. Belt³, M. Kauppi²

¹Division of Orthopaedic and Trauma Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland; ²Department of Rheumatology and ³Department of Orthopaedic Surgery, Rheumatism Foundation Hospital, Heinola, Finland; ⁴Harvard Medical School, Massachusetts General Hospital, Boston, USA

ABSTRACT
Objective
To evaluate whether cervical spine changes are associated with the destruction of shoulder or peripheral joints and with bone mineral density (BMD) in patients with long-term RA.

Methods
An inception cohort of 67 patients with seropositive and erosive RA were followed up for 20 years. Cervical spine, shoulder, hand and foot radiographs, and the BMD of the lumbar spine and femoral neck were evaluated.

Results
A positive relationship was detected between the occurrence of atlantoaxial disorders and the destruction of both shoulder (p < 0.001) and peripheral (p = 0.001) joints. In addition, the severity of anterior atlantoaxial subluxation and atlantoaxial impaction positively correlated with the grade of destruction in the evaluated joints. Furthermore, patients with atlantoaxial disorders presented decreased BMD of the femoral neck (p = 0.019). The occurrences of subaxial subluxations (SAS) and subaxial disc space narrowings only associated with higher onset age of RA.

Conclusions
Patients with severe RA and osteoporosis have an increased risk for atlantoaxial disorders. The co-existence of shoulder destruction and cervical spine disorders makes the differential diagnosis of shoulder and neck pain challenging.

Key words
Rheumatoid arthritis, cervical spine, bone mineral density, peripheral joints, shoulder joint, risk factors.

Please address correspondence to: Dr Marko Neva, Division of Orthopaedic and Trauma Surgery, Department of Surgery, Tampere University Hospital, PL 2000, 33521 Tampere, Finland.
E-mail: marko_neva@yahoo.com