Journal List > J Korean Rheum Assoc > v.14(1) > 1003602

Chang, Kim, and Yoon: A Case of Rheumatoid Arthritis Presenting Initially as Atlantoaxial Subluxation


We report here on a case of rheumatoid arthritis (RA) that progressed from the spine to the peripheral joints. In RA, the involvement of the cervical spine usually correlates with the progressive erosion of peripheral joints, such as the hand or foot, and the elevation of disease activity. Generally, it takes over 2 years of rheumatoid involvement of the cervical spine to cause laxity of the transverse ligament. The common types of rheumatoid cervical spine are anterior atlantoaxial subluxation, vertical subluxation and subaxial subluxation. We describe a 61-year-old woman with only neck pain initially. An MRI of the cervical spine showed atlantoaxial subluxation with features of the rheumatoid involvement. Arthritis later developed in both hands and symmetrically in other peripheral joints. She was diagnosed as having RA. This is the first case report of RA presenting initially as atlantoaxial subluxation.


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Fig. 1.
Cervical spine lateral flexion view. Subluxation of the first cervical vertebra on the odontoid. C-spine flexion image shows anterior slippling of the atlas on the axis. Narrowing of the C2-3 and C5-6 interspace without hypertrophic change suggests rheumatoid arthritis.
Fig. 2.
Cervical MRI. (A) A sagittal T1-weighted spin echo image of the upper cervical spine reveals a mass of intermediate signal intensity (arrow) that is eroding the odonotoid process and mild indentation of the anterior thecal sac. (B) A sagittal T2-weighted spin echo image of the upper cervical spine reveals a mass of heterogeneous intermediate signal intensity (arrow) that is same findings in T1-weighted spin echo image and eroding the lateral masses of the atlas.
Fig. 3.
Hand AP x-ray shows soft tissue swelling on 2nd, 3rd and 4th PIP joints. Mild osteoporosis is also noted on juxta-articular portion of the hands.
Fig. 4.
Bone scan reveals multiple symmetric increased uptakes on bont knees, ankles, wrists and upper cervical spine (C1-2).
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