THE CERVICAL-SPINE IN RHEUMATOID-ARTHRITIS - RELATIONSHIP BETWEEN NEUROLOGIC SIGNS AND MORPHOLOGY ON MR-IMAGING AND RADIOGRAPHS

Objective. Comparison of clinically observed neurologic long tract sig ns in a heterogeneous group of patients with rheumatoid arthritis (RA) , with morphologic abnormalities of the cervical spine as depicted on radiographs and magnetic resonance (MR) images. Design. The patients w ere prospectively assigned to one of three classes on the basis of the ir neurologic status. Lateral cervical spine radiographs and sagittal T1-weighted and gradient echo images were performed. The qualitative M R features evaluated were erosion of the dens and atlas, brain stem co mpression, subarachnoid space encroachment, pannus around the dens, ap pearance of the fat body caudal to the clivus, and the signal intensit y of the pannus. The quantitative imaging parameters were the cervicom edullary angle and the distance of the dens to the line of McRae. Pati ents. Sixty-three consecutive patients with RA and subjective symptoms , especially neck or occipital pain, and/or clinical objective signs c onsistent with a compromised cervical cord were included in this study . Results and conclusions. Damage documented with radiographs and MR i maging in patients with RA is often severe, even in those without neur ologic signs (class 1). None of the abnormalities confined to the atla ntoaxial level correlated significantly with neurologic classification . Subarachnoid space encroachment anywhere in the entire cervical spin e did correlate significantly with neurologic classification.