Rheumatoid arthritis of the cervical spine--clinical considerations.

摘要: Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder affecting multiple organ systems, joints, ligaments, and bones commonly involves the cervical spine. Chronic synovitis may result in bony erosion ligamentous laxity that instability subluxation. Anterior atlantoaxial subluxation (AAS) most frequently occurring deformity, due to of primary secondary restraints. Additional manifestations RA include cranial settling, subaxial subluxation, or combination these. Although clinical findings can be confounded by severity multifocal joint involvement, careful history critical identify symptoms disease; serial physical examination best noninvasive diagnostic tool. Thorough neurologic examinations should performed all patients functional assessments charted. Radiographs spine with lateral flexion-extension dynamic views obtained periodically used "clear" before elective surgery requiring general anesthesia. Advanced imaging, such as magnetic resonance imaging (MRI) myelography computed tomography (CT), necessary evaluate neuraxis. Early initiation pharmacotherapy slow progression rheumatoid disease. Operative intervention onset advanced myelopathy results improved outcomes compared surgical stabilization whose conditions are more advanced. A multidisciplinary approach involving rheumatology, surgery, rehabilitation beneficial optimize outcomes.