PROGRESSION OF CERVICAL-SPINE CHANGES IN PATIENTS WITH EARLY RHEUMATOID-ARTHRITIS

Objective. To evaluate the development and progression of radiological changes of cervical spine in early rheumatoid arthritis (RA). Methods . Sixty-seven patients with early RA treated actively with disease mod ifying antirheumatic drugs were followed prospectively for a mean of 6 .5 years. Conventional clinical and laboratory variables were used for measuring disease activity and radiographs of the cervical spine, han ds, and feel were taken serially during the followup. Results. Thirty percent (20/67) of the patients showed radiological evidence of the ce rvical spine involvement characteristic of RA. Atlantoaxial subluxatio n was the first type of cervical change to occur, followed by vertical and subaxial subluxations and erosions. Patients with cervical involv ement were initially more often rheumatoid factor positive and had hig her initial C-reactive protein level than patients without cervical ch anges. Also. radiological progression of peripheral joints was associa ted with cervical involvement, HLA-DR4 or B27 positivity did not seem to influence early involvement of cervical spine. Conclusion. Involvem ent of the cervical spine begins early in RA. Therefore, cervical radi ographs should be included in the clinical evaluation during the first years of disease onset, especially in patients with rapid radiologica l progression in peripheral joints. Aggressive therapy is emphasized i n these patients, including the conservative treatment of cervical spi ne.