Although rheumatoid arthritis (RA) is most commonly associated with peripheral joints, cervical spine involvement can be seen in almost 80% of patients in the presence of long-term disease, joint erosion, and risk factors such as male sex and rheumatoid factor positivity. It is very rare to have cervical involvement in the initial period of RA. If a patient has isolated cervical spine involvement without peripheral arthritis, it is highly likely that inappropriate investigations and delayed treatment may occur. Any damage that occurs in cervical spine may cause symptoms varying from slight instability to atlantoaxial subluxation, spinal cord and brain stem compression and even death. Therefore, physician should be aware that there may be isolated cervical involvement, albeit rare, in patients with RA. In this report, we presented a case of RA presenting with cervical spine involvement without peripheral arthritis to underline the importance of this kind of involvement in clinical practice. We also briefly reviewed other cases similar to ours in light of literature.
This is a preview of subscription content, log in to check access
Study concept and design: EB, DUC and CK; analysis and interpretation of data: EB, DUC, AE, CÇ and CK; drafting of the manuscript: EB, AE and DUC; critical revision of the manuscript for important intellectual content: EB, DUC and CK; study supervision: EB, DUC, AE CÇ and CK.
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Garrod AE (1890) A treatise on rheumatism and rheumatoid arthritis. Charles Griffin and Co., LondonGoogle Scholar
Bland JH, Davis PH, London MG, Vanbuskirk FW, Duarte CG (1963) Rheumatoid arthritis of cervical spine. Arch Intern Med 112:892–898CrossRefPubMedGoogle Scholar
Dreyer SJ, Boden SD (1999) Natural history of rheumatoid arthritis of the cervical spine. Clin Orthop Relat Res 366:98–106CrossRefGoogle Scholar
Hagenow A, Seifert J, Zeissig A, Conrad K, Kleymann A, Aringer M (2013) Relevant incidence of cervical arthritis in patients with erosive seropositive rheumatoid arthritis even today. Clin Exp Rheumatol 31:213–218PubMedGoogle Scholar
Krauss WE, Bledsoe JM, Clarke MJ, Nottmeier EW, Pichelmann MA (2010) Rheumatoid arthritis of the craniovertebral junction. Neurosurgery 66:83–95CrossRefPubMedGoogle Scholar
Wasserman BR, Moskovich R, Razi AE (2011) Rheumatoid arthritis of the cervical spine–clinical considerations. Bull NYU Hosp Jt Dis 69:136–148PubMedGoogle Scholar
Gurley JP, Bell GR (1997) The surgical management of patients with rheumatoid cervical spine disease. Rheum Dis Clin N Am 23:31732CrossRefGoogle Scholar
Blom M, Creemers MC, Kievit W, Lemmens JA, van Riel PL (2013) Long-term follow-up of the cervical spine with conventional radiographs in patients with rheumatoid arthritis. Scand J Rheumatol 42:281–288CrossRefPubMedGoogle Scholar
Yurube T, Sumi M, Nishida K et al (2012) Kobe Spine Conference. Incidence and aggravation of cervical spine instabilities in rheumatoid arthritis: a prospective minimum 5-year follow-up study of patients initially without cervical involvement. Spine 37:2136–2144CrossRefPubMedGoogle Scholar
Ahn JK, Hwang JW, Oh JM et al (2011) Risk factors for development and progression of atlantoaxial subluxation in Korean patients with rheumatoid arthritis. Rheumatol Int 31:1363–1368CrossRefPubMedGoogle Scholar
Del Grande M, Del Grande F, Carrino J, Bingham CO, Louie GH (2014) Cervical spine involvement early in the course of rheumatoid arthritis. Semin Arthritis Rheum 43:738–744CrossRefPubMedGoogle Scholar
Jiménez CP, Ayuga LF, Munoz EF, Lobato CP (2010) Cervical myelopathy by rheumatoid pannus as onset form of rheumatoid arthritis. Med Clin (Barc) 135:432–433CrossRefGoogle Scholar
Guilpain P, Kettaneh A, Chamouard JM, Stirnemann J, Thomas M, Fain O (2003) Compression of the spinal cord revealing a seronegative rheumatoid arthritis. Rev Med Interne 24:59–62CrossRefPubMedGoogle Scholar
Haeusler U, Dybowski F, Wittkaemper TA, Kisters K, Godolias G, Braun J (2010) Atlantoaxiale Arthritis mit entzündlichem Nackenschmerz als Erstmanifestation einer seronegativen rheumatoiden arthritis. DMW-Deutsche Medizinische Wochenschrift 135:1729–1732CrossRefGoogle Scholar
Araújo F, Silva I, Sepriano A, Reizinho C, Marques L, Nero P, Branco JC (2015) Cervical spine involvement as initial manifestation of rheumatoid arthritis: a case report. Acta Reumatol Port 40:64–67PubMedGoogle Scholar
Winfield J, Cooke D, Brook AS, Corbett M (1981) A prospective study of the radiological changes in the cervical spine in early rheumatoid disease. Ann Rheum Dis 40:109–114CrossRefPubMedPubMedCentralGoogle Scholar
Zhu S, Xu W, Luo Y, Zhao Y, Liu Y (2017) Cervical spine involvement risk factors in rheumatoid arthritis: a meta-analysis. Int J Rheum Dis 20:541–549CrossRefPubMedGoogle Scholar
Joaquim AF, Ghizoni E, Tedeschi H, Appenzeller S, Riew KD (2015) Radiological evaluation of cervical spine involvement in rheumatoid arthritis. Neurosurg Focus 38:E4CrossRefPubMedGoogle Scholar
Boden SD (1994) Rheumatoid arthritis of the cervical spine. Surgical decision making based on predictors of paralysis and recovery. Spine 19:2275–2280CrossRefPubMedGoogle Scholar
Menezes AH, VanGilder JC, Clark CR, el-Khoury G (1985) Odontoid upward migration in rheumatoid arthritis: an analysis of 45 patients with cranial settling. J Neurosurg 63:500–509CrossRefPubMedGoogle Scholar
Kauppi MJ, Neva MH, Laiho K et al (2009) FIN-RACo Trial Group. Rheumatoid atlantoaxial subluxation can be prevented by intensive use of traditional disease modifying antirheumatic drugs. J Rheumatol 36:273–278CrossRefPubMedGoogle Scholar
Kaito T, Hosono N, Ohshima S et al (2012) Effect of biological agents on cervical spine lesions in rheumatoid arthritis. Spine 37:1742–1746CrossRefPubMedGoogle Scholar