Lilia Daoud
Samir Kochbati


Aim : To investigate by magnetic resonance (MR) imaging the occurence of cervical spine (CS) involvement in rheumatoid arthritis (RA) patients.
Thirty consecutive unselected patients, who fulfilled the revised American College of rheumatology criteria for RA, Were investigated. All patients had a complete physical and laboratory evaluation. Radiological evaluation included hand and wrist x-rays, as well as CS radiographs in anteroposterior, lateral and lateral in full flexion views. In addition, MR (Spin Echo T2-weighted saggital scans, palin and contrast enhanced T1-weighted sagittal and axial scans) was performed in all patients. Hand x-rays were evaluated according to the Sharp score. Disease activity was assessed by disease activity score for 28 joint indices (DAS-28).
Results: There were 25 females and 5 males with a mean age of 46.6 years (23-67) and mean disease duration 9years (1-22). Twenty three patients (76.6%) had positive IgM rheumatoid factor (RF). five patients presented clinical findings, mainly cervical pain and stiffness of CS ( four with positive and one with negative MR), while radiological findings of CS involvement were found in seven patients (23%). Five patients (16.6%) presented MR findings of CS involvement (anterior atlantoaxial subluxation 100%; vertical subluxation 20%; peridental pannus 80%; dens erosion 40%; brainstem compression 20%). Atlantoaxial subluxation correlated with high DAS-28, high level of swellen joint, high level of Créacitve protéin and advanced erosive changes of the wrist and hand (high level of Sharp score) in the univariate analysis.
Conclusion: We conclude that the frequency of CS involvement in RA patients is high. In pateints with active erosive peripheral disease it is very probable to also have some changes in CS. These may be clinically important and in such cases, MR offer valuable information.


Arthritis rheumatoid, magnetic resonance imaging, cervical spine



  1. Bland JH: Rheuamtoid arthritis of the cervical spine: J Rheumatol 1974;1:319-42.
  2. Hallat JT, Hardin JG, Vitek J, Alarcon GC: involvement of the cervical spine in rheumatoid arthritis. Arthritis Rheum 1989;32:652-9.
  3. Paimela L, Laasonen L, Kankaanpaa N, Leirisalo-repo M. Progression of cervical spine changes in patients with early rheumatoid arthritis. J Rheumatol 1997;24:1280-4.
  4. Reijnierse M, Bloem JL, Dijkmans Bac et al: The cervical spine in rheumatoid arthritis: relationship between neurologic signs and morphology on MR imaging abd radiographs. Skeletal radiolo 1996;25:113-8.
  5. Reijnierse M, Breedveld FC, Kroon HM, Hansen B, Pope TL, Bloem JL: Are magnetic resonance flexions views useful in evaluating the cervical spine of patients with rheumatoid arthritis. Skeletal radiology 2000; 29:85-9.
  6. Reijnierse M, Dukmanns Bac, Hansen B et al: neurologic dysfunction in patients with rheumatoid arthritis of the cervical spine. Predictive value of clinical radiographic and MR imaging parameters. Eur Radiology 2001;11:467-73.
  7. Arnett FC, Edworthy SM, Bloch DA et al: The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315-24.
  8. Prevoo ML, Van't Hof MA, Kuper HH, Van De Putt LB, van Riel PL: Modified disease activity acores that include twenty-eightjoint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995;38:44-8
  9. Wienfield J, Cook D, Brook AS, Corbett M: A prospective study of the radiological changes in the cervical spine in early rheumatoid disease. 1981;40:109-14.
  10. Sugimoto H, Takeda A, Kano S: Assessment of disease activity in rheumatoid arthritis using magnetic resonance imaging: quantification of pannus volume in hands. Br J Rheumatol 1998;37:854-61.
  11. Kauppi M, Hakala M. Prevalence of cervical spine subluxations and dislocations in a community-based rheumatoid arthritis population. Scand J Rheumatol 1994;23:133-6.
  12. Kauppi M, Neva MH. Sensitivity of lateral view cervical spine radiographs taken in neutral position in atlantoaxial subluxations in rheumatic disease. Clin Rheumatol 1998; 17:511-14
  13. Mathews JA. Atlanto-axial subluxation in RA. ARD 1974; 33:526-32.
  14. Dvorak J, Grob D, Grauer W, larson S. Functional evaluation of the spinal cord by magnetic resonance imaging in patients with rheumatoid arthritis and unstability of upper cervical spine. Spine 1989;14:1057-64.
  15. O'brien MF, Casey AT, Crockard A. Histology of the craniocervical junction in chronic rheumatoid arthritis. Spine 2002;27:2245-54.
  16. Einig M, Higer HP, Meairs S, Faust G. Magnetic resonance imaging of the craniocervical junction in rheumatoid arthritis: Value, limitations, indication. Skeletal Radiol 1990;19:341-6.
  17. Laiho K, Soini I, Kauppi M. Can we rely on MRI when evaluating unstable atlantoaxial subluxation. Annal Rheum Dis 2003;62:254-6.
  18. A K Zikou, MI Argyropoulou, Y Alamanos, A.A.Drosos. Magnetic resonance imaging of the cervical spine in patients with rheumatoid arthritis. A Cross-sectional study. Clinical and Exp Rhumatol. 2005;23:665-670.
  19. Allmann KH,UHL M, Von Kempis J. Functional MR imaging of the cevical spine in patients with rheumatoid arthritis. Acta radiol 1995;39:543-6.
  20. Sugimoto H, Takeda A, Masuyama J. Early stage rheumatoid arthritis: diagnostic accuracy of MR imaging. Radiology 1996;198:185-92.
  21. Neva MH, Isomaki P, Hannonen P. Early and extensive erosiveness in peripheral joints predicts atlantoaxial subluxations in patients with rheumatoid arthritis. Arthritis Rheuma 2003; 48: 1808-13.
  22. Oda T, Fujiwara K, Yonenobu K, Azuma B. Natural course of cervical spine lesions in rheumatoid arthritis. Spine 1995;20:1128-35.