Rheumatoid Arthritis- Craniovertebral Involvement
The spondylitis of RA is distinctive in that it has predilection for the cervical region. Osteoporosis, disc narrowing and end-plate irregularity are seen with only minimal reactive new bone formation in the upper cervical vertebrae in contrast to the osteoarthritis which involves lower cervical vertebrae.
Facet joint erosions may lead to subluxations at multiple levels in cervical spine giving STEP-LADDER appearance. Atlantoaxial joint subluxation is seen in 30% of cases especially in chronic disease due to involvement of transverse ligament with or without erosion of odontoid. (Separation between anterior border of odontoid and posterior surface of the anterior arch of atlas in flexion of more than 2.5 mm in adults or 4mm in children is considered diagnostic of AAD). The eroded odontoid at times may fracture.
In our case. T1 and T2 weighted images reveal pannus which is hypointense on T1 and T2 with erosion of odontoid peg. Altered signal intensity is also seen in cord at this level due to ischemia/oedema. Mild compression of thecal sac is also noted.
Facet joint erosions may lead to subluxations at multiple levels in cervical spine giving STEP-LADDER appearance. Atlantoaxial joint subluxation is seen in 30% of cases especially in chronic disease due to involvement of transverse ligament with or without erosion of odontoid. (Separation between anterior border of odontoid and posterior surface of the anterior arch of atlas in flexion of more than 2.5 mm in adults or 4mm in children is considered diagnostic of AAD). The eroded odontoid at times may fracture.
In our case. T1 and T2 weighted images reveal pannus which is hypointense on T1 and T2 with erosion of odontoid peg. Altered signal intensity is also seen in cord at this level due to ischemia/oedema. Mild compression of thecal sac is also noted.
Reported by- Teleradiology Providers
Rheumatoid Arthritis- Craniovertebral Involvement
Reviewed by Sumer Sethi
on
Tuesday, December 15, 2009
Rating:
Reviewed by Sumer Sethi
on
Tuesday, December 15, 2009
Rating:
Sumer Sethi
Unique blend of academic excellence and entrepreneurship, heading leading firms in India- Teleradiology Providers, pioneering company providing teleradiology services and DAMS (Delhi Academy of Medical Sciences) Premier test preparation institute in India for MD/MS/MCI preparation. He has also been an invited faculty member at various conferences, including Teleradiology in IRIA 2008 and 2011, Hospital Build Middle East, Congress of the Brain Tumor Radiology in Neuro-oncology Society. Dr. Sethi is Editor-in-Chief of Internet Journal of Radiology. He has a keen interest in Web 2.0 technologies and in maintaining his famous radiology blog, which has been featured in multiple international journals.
1 comment:
Informative article.I hope this development will be useful for permanent solution towards arthritis problem.
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