What is rheumatoid arthritis (RA) of the cervical spine?

Updated: Aug 13, 2019
  • Author: Steven R Garfin, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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The cervical spine is the third most common site of rheumatoid arthritis (RA), after the metatarsophalangeal joints and the metacarpophalangeal joints. Rheumatoid spondylitis primarily affects the cervical spine; involvement of the thoracic or lumbar spine is rare. (In contrast, ankylosing spondylitis primarily involves the sacroiliac joints and lumbosacral spine. [1] ) The anatomic abnormalities occur as a consequence of the destruction of synovial joints, ligaments, and bone.

Rheumatoid abnormalities of the cervical spine generally can be grouped into the following 3 categories, which may be seen in isolation or in combination:

AAI, or atlantoaxial subluxation (AAS), is the most common abnormality (see the image below). AAS can be a fixed deformity or can be partially or fully reducible.

Rheumatoid spondylitis. Depiction of anterior subl Rheumatoid spondylitis. Depiction of anterior subluxation of C1 on C2, retrodental pannus, and osseous erosions; the spinal cord is compressed between the pannus anteriorly and the posterior arch of the atlas.

Superior migration of the odontoid (SMO), the second most common abnormality, has alternately been referred to as cranial settling, pseudobasilar invagination, or vertical/upward translocation of the odontoid. [2]  (See the following images.)

Rheumatoid spondylitis. Depiction of superior migr Rheumatoid spondylitis. Depiction of superior migration of the odontoid into the foramen magnum with compression of the spinal cord.
Rheumatoid spondylitis. Pertinent measurements of Rheumatoid spondylitis. Pertinent measurements of superior migration of the odontoid; cranial migration distance (CMD).

 Subaxial subluxation, the least common deformity, may be seen at multiple levels. It produces a stepladder deformity.

See  Rheumatoid Arthritis and Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy for more information on these topics.

See Rheumatoid Arthritis: In and Out of the Joint, a Critical Images slideshow, to help identify the distinguishing features of RA as well as the signs of extra-articular manifestations of this disfiguring disease.

For patient education information, see Rheumatoid Arthritis and Rheumatoid Arthritis Medications.

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